A 15 year old male was an unrestrained passenger in a high speed motor vehicle crash followed by ejection. The patient was noted to have evidence of bilateral
pneumothorax upon arrival in the Emergency Department. Bilateral
chest tubes were placed under sterile conditions; however, the left
pneumothorax remained, and a second left
chest tube was placed. Repeat chest radiographs revealed extensive
subcutaneous emphysema,
pneumomediastinum, and
pneumopericardium. Needle aspiration of the pericardium returned significant quantities of air, an immediate improvement in blood pressures followed. An 18-gauge triple lumen
catheter was placed into the pericardial space for additional withdrawal of air via syringe. Mechanisms have been proposed to explain the development of tension
pneumopericardium after chest
trauma. Early diagnosis is crucial, and may be found on initial chest radiographs. Computed tomography is also an effective method for evaluating the presence of air in the pericardial space and may assist in establishing the diagnosis. Tension
pneumopericardium requires immediate recognition and
decompression to prevent
cardiac tamponade with a fatal circulation collapse, an entity that is as serious as the tamponade resulting from
hemopericardium. Traumatic
pneumopericardium is rare, but can be a complicated finding associated with high-speed blunt chest
trauma. Patients with evidence of
pneumopericardium should be closely monitored, particularly those supported by
positive pressure ventilation.