title: Spontaneous tension pneumopericardium.
abstract: A 29-year-old man presented to the accident and emergency department complaining of a sudden onset of chest and upper abdominal pain. He had a past history of intravenous drug abuse and a previous stab wound to the left hypochondrium that had required laparotomy. On arrival he was distressed with grunting respiration. Initial chest X-ray showed a pneumopericardium. Despite titrated doses of opiate analgesia he became increasingly distressed, agitated and dyspnoeic. Repeat chest X-ray demonstrated an increase in the volume of air present within the pericardial sac. His clinical condition improved rapidly after needle pericardiocentesis decompression. A water-soluble contrast swallow revealed a diaphragmatic hernia with a filling defect in the greater curve of the stomach and contrast medium entering the pericardial sac. A thoraco-abdominal laparotomy confirmed a pre-existing diaphragmatic defect from the previous stab wound, with surrounding adhesions. A small portion of the stomach had herniated through this defect with a perforated gastric ulcer communicating directly into the pericardial sac.
authors.affiliation: Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, Scotland, UK. steveboyce_scotland@yahoo.com
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Boyce
authors.forename: Alasdair R
authors.initials: AR
authors.lastname: Corfield
authors.forename: A Crawford
authors.initials: AC
authors.lastname: McGuffie
authors.forename: James
authors.initials: J
authors.lastname: Stevenson
authors.forename: David
authors.initials: D
authors.lastname: Rawlings
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D008297:Male; D010439:Peptic Ulcer Perforation / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D020519:Pericardiocentesis / Q000379:methods; D011026:Pneumopericardium / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D013902:Radiography, Thoracic; D013276:Stomach Ulcer / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015819:Substance Abuse, Intravenous / Q000150:complications; D016896:Treatment Outcome