In 1997, a 53-year-old male smoker was admitted for progressive
shortness of breath associated with a productive
cough and yellowish sputum, pleuritic
chest pain, and low-grade
fever. There was no history of
trauma. A posterior-anterior chest radiograph showed a diffuse infiltrate through the right lung field and an air space parallel to the lateral border of the heart. A computed tomographic scan of the chest confirmed
pneumopericardium, with no associated
pericardial effusion. It also showed a cavitary infiltrate in the anterior basal segment of the right lower lobe, but no definite
neoplasm. Cultures of the sputum grew Staphylococcus aureus. The patient had positive
antibodies to human immunodeficiency virus (HIV),
hepatitis A, and
hepatitis B. A bronchial biopsy from the right lower lobe showed well differentiated infiltrating
squamous cell carcinoma with an acute inflammatory exudate. No bronchopericardial
fistula was noted. After
antibiotic treatment, a repeat chest radiograph showed resolution of
pneumopericardium and improvement of the chest infiltrate. Repeat computed tomography of the chest showed that the
pneumopericardium had resolved, but now revealed a large
pericardial effusion. No bronchopericardial
fistula could be demonstrated. Unfortunately, our patient refused further investigation.
Pneumopericardium is a rare disorder. In adults,
pneumopericardium most commonly results from
trauma. Although many other reports link
pneumopericardium to an underlying disease process, our patient with
HIV antibodies developed
pneumopericardium despite having no history of
trauma and no documentation of a communicating
fistula. To our knowledge, there has been no previous report of
pneumopericardium in association with
acquired immunodeficiency syndrome.