title: Pneumopericardial tamponade resulting from a spontaneous gastropericardial fistula.
abstract: Pneumopericardium is a rare but serious cause of morbidity and mortality. Untreated, it can lead to cardiac tamponade and thus must be promptly identified to treat the underlying etiology. Here, we report a case of spontaneous pneumopericardium secondary to gastric ulcer perforation in association with a hiatal hernia. The diagnosis of pneumopericardium was first made under fluoroscopy during cardiac catheterization and a follow-up CT of the chest revealed a gastropericardial fistula as the initiating event. The patient underwent emergent thoracotomy and partial esophagogastrectomy which eventually resulted in a full recovery and discharge on postoperative day 19. Our unique experience with this rare and often fatal disease suggests that early diagnosis combined with an early and aggressive surgical strategy is critical for minimizing morbidity and mortality.
authors.affiliation: Department of Cardiology, The University of Toledo Medical Center, Toledo, Ohio 43614, USA. steven.bruhl@utoledo.edu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Bruhl
authors.forename: Kiranmayee
authors.initials: K
authors.lastname: Lanka
authors.forename: William R
authors.initials: WR
authors.lastname: Colyer
mesh_terms: D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004562:Electrocardiography; D016629:Esophagectomy; D005402:Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005471:Fluoroscopy; D005743:Gastrectomy; D005747:Gastric Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications; D011026:Pneumopericardium / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013276:Stomach Ulcer / Q000150:complications; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome