title: Management of a pneumopericardium due to penetrating trauma.
abstract: BACKGROUND
  A pneumopericardium presenting after penetrating chest trauma is a rare event. The surgical management of this clinical problem has not been clearly defined. The aim of this study was to document the mode of presentation and to suggest a protocol for management.
  
  
  METHODS
  A review of a prospectively collected cardiac database of patients presenting to Groote Schuur Hospital Trauma Centre between October 2001 and February 2009 with a pneumopericardium on chest X-ray after penetrating trauma.
  
  
  RESULTS
  There were 27 patients with a pneumopericardium (mean age 25 years, range 17-36). The mechanism of injury was a stab wound to the chest in 26 patients and a single patient with multiple low velocity gunshot wounds. Six patients (22%) were unstable and required emergency surgery. One of these patients presented with a tension pneumopericardium. Twenty-one patients were initially stable. Two of these (10%) patients later developed a tension pneumopericardium within 24-h and were taken to theatre. The remaining 19 patients were managed with a subxiphoid pericardial window (SPW) at between 24 and 48h post admission. Ten of these 19 patients (52%) were positive for a haemopericardium. Only 4 of the 19 underwent a sternotomy and only two of these had cardiac injuries that had sealed. There were no deaths in this series.
  
  
  CONCLUSIONS
  Patients with a penetrating chest injury with a pneumopericardium who are unstable require emergency surgery. A delayed tension pneumopericardium developed in 10% of patients who were initially stable. It is our recommendation that all stable patients with a pneumopericardium after penetrating chest trauma should undergo a SPW. A sternotomy is not required in stable patients.
authors.affiliation: Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. Electronic address: andrew.nicol@uct.ac.za.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.affiliation: Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Pradeep H
authors.initials: PH
authors.lastname: Navsaria
authors.affiliation: Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Martijn
authors.initials: M
authors.lastname: Hommes
authors.affiliation: Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Sorin
authors.initials: S
authors.lastname: Edu
authors.affiliation: Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Delawir
authors.initials: D
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D004632:Emergency Medical Services; D006801:Humans; D010491:Pericardial Window Techniques; D011026:Pneumopericardium / Q000209:etiology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D056346:Sternotomy / Q000706:statistics & numerical data*; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Penetrating cardiac injury; Penetrating cardiac trauma; Pneumopericardium; Subxiphoid pericardial window