Pneumopericardium and aortic rupture

Gutiérrez Caracuel FJ, Vázquez González A, Aponte Tomillo I, García Falcón A

Pneumopericardium is defined as the presence of air within the

pericardial sac; it may be the cause of cardiac tamponnade. We

here report the case of a 21-year-old male who, after suffering a

motorcycle accident, was admitted to hospital conscious but anxious,

with marked dyspnoea and tachypnoea and with a peripheral oxygen

saturation level of 88%. The clinical examination disclosed marked thoracic

subcutaneous emphysema mainly on the right haemithorax and

extending to the side of the abdomen. On auscultation there was a

marked diminution of the vesicular murmur in the right haemithorax.

Orotracheal intubation was performed immediately and a central venous

access catheter was inserted with crystalloid administration. An

abdominal ultrasound scan and thoracocentesis were performed. The

plain chest film (portable apparatus) disclosed haemothorax and multilobar

lung contusion and an image highly suggestive of pneumopericardium.

The patient died 15 minutes after admission. The Forensic

Pathology examination (the report was received later) demonstrated

rupture of the thoracic aorta and posed reasonable doubts as to the

immediate cause of death: cardiac tamponnade secondary to the pneumopericardium or haemorrhagic hypovolaemic shock.

Aponte Tomillo I, García Falcón A, Gutiérrez Caracuel FJ, Vázquez González A