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Pneumopericardium after pericardiostomy
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MODEL
Journal of the Formosan Medical Association (2016) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
CORRESPONDENCE
Pneumopericardium after pericardiostomy Sang-Ho Cho a, Hui-Jeong Hwang b, Chang-Bum Park b,* a Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea b Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
Received 15 December 2015; received in revised form 21 January 2016; accepted 7 March 2016
An 81-year-old woman presented to our hospital with complaints of abdominal discomfort and mild dyspnea. The chest radiograph showed cardiomegaly, and echocardiographic findings showed a moderate to severe pericardial effusion. Pericardiostomy through the subxiphoid area was performed, and 600 mL of hemorrhagic pericardial fluid was aspirated and a chest tube was inserted at the pericardial sac. On the next day, the patient became asymptomatic; her blood pressure was 113/66 mmHg and heart rate was 91 beats/min but pneumopericardium was evident on the chest radiograph (Figure 1). We found that the pneumopericardium was caused by an incorrectly connected watersealed drainage system in the chest bottle. We readjusted it immediately and performed suction with negative pressure to drain the air rapidly. A follow-up chest radiograph showed a decrease in the amount of air. At this point, the patient’s blood pressure was 107/68 mmHg and heart rate was 76 beats/min. We removed the chest tube 7 days later and she was discharged without complications. Pneumopericardium is a rare condition and the most common causes are traumatic injury, complications of diagnostic and therapeutic procedures such as pericardiocentesis, barotrauma, infection or fistula to the pericardium, pulmonary emphysema, pulmonary aspergillosis, and aspiration of foreign body.1 A meticulous procedural technique and close postprocedural surveillance is
Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Republic of Korea. E-mail address: [email protected] (C.-B. Park).
key to prevent this complication. Oxygen therapy and symptomatic treatment are sufficient in hemodynamically stable patients but immediate aspiration or surgical treatment is needed in hemodynamically unstable patients.2,3 As in our case, the connecting system for water-sealed drainage in the chest bottle is a little complicated to trainees, and therefore, educating the house staff to deal with the chest bottle system is necessary to prevent further safety events.
Figure 1 Chest X-ray shows lucent outline (black arrows) representing the pericardial sac around the heart with clear lung. The chest tube (white arrow) is placed into the pericardial sac through the subxiphoid area.
http://dx.doi.org/10.1016/j.jfma.2016.03.003 0929-6646/Copyright ª 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Cho S-H, et al., Pneumopericardium after pericardiostomy, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.03.003
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References 1. Myszka W, Nowak A. Chest pain, dyspnea and hypotension in a 61-year-old woman. Heart 2015;101:960.
S.-H. Cho et al. 2. Mullens W, Dupont M, De Raedt H. Pneumopericardium after pericardiocentesis. Int J Cardiol 2007;118:e57. 3. Choi WH, Hwang YM, Park MY, Lee SY, Lee HY, Kim SW, et al. Pneumopericardium as a complication of pericardiocentesis. Korean Circ J 2011;41:280e2.
Please cite this article in press as: Cho S-H, et al., Pneumopericardium after pericardiostomy, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.03.003
MODEL
Journal of the Formosan Medical Association (2016) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
CORRESPONDENCE
Pneumopericardium after pericardiostomy Sang-Ho Cho a, Hui-Jeong Hwang b, Chang-Bum Park b,* a Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea b Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
Received 15 December 2015; received in revised form 21 January 2016; accepted 7 March 2016
An 81-year-old woman presented to our hospital with complaints of abdominal discomfort and mild dyspnea. The chest radiograph showed cardiomegaly, and echocardiographic findings showed a moderate to severe pericardial effusion. Pericardiostomy through the subxiphoid area was performed, and 600 mL of hemorrhagic pericardial fluid was aspirated and a chest tube was inserted at the pericardial sac. On the next day, the patient became asymptomatic; her blood pressure was 113/66 mmHg and heart rate was 91 beats/min but pneumopericardium was evident on the chest radiograph (Figure 1). We found that the pneumopericardium was caused by an incorrectly connected watersealed drainage system in the chest bottle. We readjusted it immediately and performed suction with negative pressure to drain the air rapidly. A follow-up chest radiograph showed a decrease in the amount of air. At this point, the patient’s blood pressure was 107/68 mmHg and heart rate was 76 beats/min. We removed the chest tube 7 days later and she was discharged without complications. Pneumopericardium is a rare condition and the most common causes are traumatic injury, complications of diagnostic and therapeutic procedures such as pericardiocentesis, barotrauma, infection or fistula to the pericardium, pulmonary emphysema, pulmonary aspergillosis, and aspiration of foreign body.1 A meticulous procedural technique and close postprocedural surveillance is
Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Republic of Korea. E-mail address: [email protected] (C.-B. Park).
key to prevent this complication. Oxygen therapy and symptomatic treatment are sufficient in hemodynamically stable patients but immediate aspiration or surgical treatment is needed in hemodynamically unstable patients.2,3 As in our case, the connecting system for water-sealed drainage in the chest bottle is a little complicated to trainees, and therefore, educating the house staff to deal with the chest bottle system is necessary to prevent further safety events.
Figure 1 Chest X-ray shows lucent outline (black arrows) representing the pericardial sac around the heart with clear lung. The chest tube (white arrow) is placed into the pericardial sac through the subxiphoid area.
http://dx.doi.org/10.1016/j.jfma.2016.03.003 0929-6646/Copyright ª 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Cho S-H, et al., Pneumopericardium after pericardiostomy, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.03.003
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MODEL
2
References 1. Myszka W, Nowak A. Chest pain, dyspnea and hypotension in a 61-year-old woman. Heart 2015;101:960.
S.-H. Cho et al. 2. Mullens W, Dupont M, De Raedt H. Pneumopericardium after pericardiocentesis. Int J Cardiol 2007;118:e57. 3. Choi WH, Hwang YM, Park MY, Lee SY, Lee HY, Kim SW, et al. Pneumopericardium as a complication of pericardiocentesis. Korean Circ J 2011;41:280e2.
Please cite this article in press as: Cho S-H, et al., Pneumopericardium after pericardiostomy, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.03.003