Last update: April 2020

Pneumopericardium is a rare disease. It is defined as the presence of air or gas in the pericardial sac.

Causes of pneumopericardium

  Gas-producing infections of the pericardium.

  Blunt or penetrating chest trauma.

  Fistulous connection between the esophagus and pericardial cavity (due to lymphoma or infection).

  Fistulous connection between the trachea and pericardial cavity (due to lymphoma).

  As a complication after gastric or esophageal surgery.

  Inhalation of 1-1-difluoroethane (may also cause cardiomyopathy or myocarditis).

  Pericardial-esophageal fistula as a complication of radiofrequency ablation for atrial fibrillation.

  Fistula between the pericardium and colon, presenting with pericarditis.

  Face-mask continuous positive airway pressure (CPAP)

ECG changes observed during pneumopericardium

  Low voltage. It has been suggested that even if frank low voltage is not evident, observation of relatively low voltage in every lead (when compared with preoperative ECGs) may prompt a search for pneumopericardium in selected postoperative patients.

  Diffuse ST segment elevation with PR depression (compatible with pericarditis)

  ST segment elevation alone (mimicking myocardial infarction). ST segment elevation may disappear after treatment of pneumopericardium.

  ST segment depression

  Right axis deviation (may disappear after treatment of pneumopericardium).

  Incomplete right bundle branch block

  Prolonged QT interval

may be normal in some patients with pneumopericardium.


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