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Pneumopericardium

What is pneumopericardium?

A double-walled sac called the pericardium surrounds your heart. The space between the walls is called the pericardial cavity. It contains fluid that helps protect the heart.

In rare cases, the pericardium can fill with air. This condition, pneumopericardium, can be life-threatening.

Pneumopericardium can lead to cardiac tamponade, which is a buildup of excess fluid in the pericardium. The excess fluid puts pressure on the heart that keeps it from working properly.

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Symptoms

What are the symptoms of pneumopericardium?

Pneumopericardium symptoms can come on suddenly. They can also be serious and worsen over time.

Symptoms of pneumopericardium include:

  • chest pain
  • rapid heart rate
  • pain in the right upper abdomen
  • pain that extends from the chest to the shoulders and back
  • nausea
  • shortness of breath
  • fainting
  • drop in blood pressure
  • signs of shock, such as limbs that are cool to the touch and pale skin

You should call 911 or local emergency services if you experience these symptoms.

Causes

What causes pneumopericardium?

Pneumopericardium is usually caused by blunt trauma to the chest. The chest injury can come from:

  • a car crash
  • a gunshot
  • a football tackle
  • an asthma attack
  • a coughing fit
  • receiving the Heimlich maneuver

Someone receiving cardiopulmonary resuscitation (CPR) with deep chest compressions could develop pneumopericardium. Most injuries that occur from these events do not affect the pericardium. Cracked ribs are much more likely to occur following a serious blow to the chest.

Also in rare cases, a woman can develop pneumopericardium delivering a baby. An infant can also be born with pneumopericardium. This is usually because air is able to enter the pericardium through the pulmonary vein.

Pneumopericardium can also be the result of barotrauma. This is an injury to the heart, ear, or other area caused by an air pressure imbalance in the body. Airplane travel or scuba diving can cause barotrauma.

Positive airway pressure devices, like those used to treat obstructive sleep apnea, push air into your airways. They may also induce pneumopericardium. Using these devices to inhale illicit drugs can also cause pneumopericardium.

An infection of the pericardium can also lead to pneumopericardium.

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Risk factors

Who is at risk for pneumopericardium?

Pneumopericardium is a rare condition that can happen to anyone at any age. Those most likely to develop the condition are football players and other athletes at risk of sudden or high-speed hits to the chest. People who work in high locations and are at risk of falls also face greater odds of developing pneumopericardium.

Babies born prematurely are also more likely than full-term babies to have pneumopericardium.

Diagnosis

How is pneumopericardium diagnosed?

Your doctor will start by reviewing your symptoms and use a stethoscope to listen to your heart for unusual sounds.

Your doctor may order three different types of imaging tests to look at your heart. These include:

CT scans are special kinds of X-rays that combine images taken from many angles. They can create detailed views of the heart, bones, blood vessels, or other body parts. Ultrasounds use sound waves to create images.

Pneumopericardium symptoms can get worse without treatment. Don’t ignore symptoms like chest pain, shortness of breath, or fainting. These can also all be symptoms of other serious conditions.

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Treatment

How is pneumopericardium treated?

Pneumopericardium is often a medical emergency. Your doctor may recommend an emergency procedure known as pericardiocentesis. This involves draining the excess fluid with a needle.

The pericardium may also need surgical repair. Sometimes this involves a sternotomy. This procedure involves “cracking” and separating the sternum, or breastbone.

For milder cases, your doctor may recommend a less invasive procedure called a pericardial window. This involves the doctor making a small incision in the upper abdomen and removing a part of the pericardium.

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Recovery

Recovery from treatment

If you have a pericardial window or a sternotomy, you should expect to stay in the hospital for a few days. This will allow doctors and nurses to watch the health of your heart and the healing of your incisions. You’ll have a follow-up appointment with your doctor a week or so after your discharge.

You should be able to resume most of your regular activities within a few weeks. You may not be able to lift anything heavy for a few months, especially if you had a sternotomy. Make sure you ask your doctor about any other restrictions during recovery.

You will probably see some improvements in your symptoms soon after treatment. Pneumopericardium caused by a sudden trauma has a faster recovery time if you received prompt treatment.

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Outlook

What is the outlook for a pneumopericardium?

There are usually no complications or long-term problems after treatment for pneumopericardium. But the outlook isn’t as good if the condition advances to tension pneumopericardium. This can cause cardiac tamponade.

Premature infants born with pneumopericardium face higher mortality risks. They may also develop respiratory distress syndrome. This can lead to serious breathing difficulties.

Getting prompt treatment is the best way to increase the chances of a positive outcome.

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