TITLE:
Pitfalls in Diagnosing a Tension Pneumopericardium—A Case Report
AUTHORS:
Shankar Hanamantrao Hippargi, Vinayak Tonne
KEYWORDS:
Tension Pneumopericardium; Cardiac Tamponade; Traumatic Pneumopericardium; Pneumo-Tamponade; Small Heart Sign
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.4 No.4,
April
30,
2013
ABSTRACT: A 65-year-old female patient was brought to our
emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and
hence she was immediately intubated and ventilated. Blood pressure and
peripheral pulses were not measurable; however the central pulses were present.
Aggressive fluid resuscitation was started. Primary assessment revealed
distended neck veins, bony crepitus over right chest. Bedside plain chest
radiograph and focused assessment with sonograph in trauma (FAST) were done which
did not establish an immediate diagnosis. Computed tomography (CT) of the
thorax revealed a tension pneumopericardium and moderate right
hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube
(ICD) was inserted on right chest. The patient suffered a cardiac arrest and
resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis
and the discussion of this rare case are presented in this case report.