Tension pneumopericardium in blunt thoracic trauma.
BACKGROUND
Pneumopericardium, defined as the presence of gas in the pericardial sac, is a rare condition caused mostly by trauma. Tension pneumopericardium is a cause of hemodynamic instability; hence, it consists in a life-threatening situation and should be regarded in blunt chest trauma.


METHODS
A 51-year-old male was victim of a 4m fall and burial. He was stable upon admission and presented a simple pneumopericardium and pneumomediastinum on CT. While being submitted to an upper digestive endoscopy he presented respiratory failure and had to be intubated, suddenly evolving to shock. He was promptly referred to the operating room; a pericardial window confirmed tension pneumopericardium and immediately hemodynamic stability was restored. A pericardial drain was placed and kept for 15days. He was discharged at the 18th day post-trauma after a satisfactory recovery at the trauma ICU.


CONCLUSIONS
Blunt thoracic trauma causes pneumopericardium by various mechanisms. Tension pneumopericardium is a possible outcome, probably related to positive-pressure ventilation. It leads to hemodynamic instability and requires immediate decompression and placement of a pericardial drain.
Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil. Electronic address: antonio.fernando.rolim.marques@gmail.com.
Antonio Fernando
AF
Rolim Marques
Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Lizianne Hermogenes
LH
Lopes
Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Marcela Dos Santos
Mdos S
Martins
Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Cesar Vanderlei
CV
Carmona
Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Gustavo Pereira
GP
Fraga
Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Elcio Shiyoti
ES
Hirano
Blunt thoracic trauma; Cardiac tamponade; Macklin effect; Pneumopericardium; Shock; Tension pneumopericardium