title: Unsuccessful resuscitation of a preterm infant due to a pneumothorax and a masked tension pneumopericardium.
abstract: Pneumopericardium is the least common form of air leak in infants. A tension pneumopericardium is even more infrequent but associated with a very high mortality rate. We describe the case of an unsuccessful resuscitation in a preterm infant due to a pneumothorax and tension pneumopericardium. Despite relatively mild pressure ventilation the patient developed massive pulmonary interstitial emphysema. The extra-alveolar air spread from the interstitium towards the mediastinal space (Macklin effect) and caused a pneumothorax and pneumopericardium, which evolved towards a tension pneumopericardium after a traumatic mechanical procedure. The infant deteriorated acutely. Despite prompt pleural drainage there were no signs of recovery at any time. Postmortal examination revealed a tension pneumopericardium and massive interstitial pulmonary emphysema, which was not obvious on radiographical investigation. In cases of acute deterioration of a ventilated neonate, one should always rule out pneumothorax. If the patient does not recover after pleural drainage and cardiac resuscitation a (tension) pneumopericardium should be considered.
authors.affiliation: Department of Neonatal Intensive Care, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium. bjorn.cools@uza.be
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.forename: Katleen
authors.initials: K
authors.lastname: Plaskie
authors.forename: Koen
authors.initials: K
authors.lastname: Van de Vijver
authors.forename: Bert
authors.initials: B
authors.lastname: Suys
mesh_terms: D017809:Fatal Outcome; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011026:Pneumopericardium / Q000150:complications / Q000628:therapy*; D011030:Pneumothorax / Q000150:complications / Q000628:therapy*; D011656:Pulmonary Emphysema / Q000209:etiology / Q000628:therapy*; D012151:Resuscitation / Q000379:methods*