Background

Pneumopericardium is a rare air-leak syndrome caused by abnormal presence of air in the pericardial space, with potentially high risk of morbidity and mortality. Clinically, it can be divided in non-tension and tension pneumopericardium, the latter resulting in a decreased cardiac output and circulatory failure. Scant data are available on non-traumatic tension pneumopericardium in non-ventilated patients.

Objectives

To describe a case of tension pneumopericardium and review the pertinent literature.

Methods

Case report and review of the literature (Pubmed search) of non-traumatic and non-ventilated pneumopericardium in children.

Results

Case: A 2-month-old infant developed cardiac tamponade due to tension pneumopericardium 11 days after cardiac surgery. The prompt treatment with pericardium drainage resolved the critical clinical conditions.

Literature review: 55 cases of pneumopericardium retrieved, a minority of which were tension pneumopericardium (17/55, 30.9%). Patients with tension pneumopericardium were predominantly males 12/16 (75.0%) with a mean age of 4.8 years. Most of the patients with non-tension pneumopericardium were children (21/38, 55.3%); patients with tension pneumopericardium were mainly newborns (6/17, 35.3%). The etiologies are reported in Figure 1. Conservative treatment was performed in all cases of non-tension pneumopericardium and pericardiocentesis in all other cases. Overall, the majority of the patients survived (41/51, 80.3%); with a lower survival rate among patients with tension pneumopericardium (62.5% vs 88.6%).

Conclusion

Pneumopericardium is a rare condition with a higher mortality rate in patients with tension pneumopericardium which requires immediate diagnosis and treatment. In non-ventilated patients tension pneumopericardium presents in younger ages, especially in patients with a history of surgery and leukemia.