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Competing Interests: Competing interests: None declared.

Gastric perforation into the pericardium is an extremely rare but lethal condition. Only a few case reports have been described in the literature. It is difficult to diagnose these patients with clinical evaluation. Accurate and immediate diagnosis of the intestinal perforation is vital. Herein, we present a 56-year old female patient with gastric perforation into the pericardium due to benign gastric ulcer diagnosed with computed tomography (CT). We also emphasized the imaging findings in the diagnosis of intestinal perforation into the pericardium., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Pneumopericardium occurs when air accumulates in the pericardial sac surrounding the heart and is one of the rarest forms of air leaks in neonates. Because of various advances in neonatal care, including gentler modes of ventilation, surfactant replacement, and antenatal steroids, the incidence of pneumopericardium has decreased. Despite the decrease in incidence of pneumopericardium, most cases arise in premature infants with a history of respiratory distress and mechanical ventilation. Evidence has shown that the incidence is inversely related to birth weight and that pneumopericardium has high mortality and morbidity rates.

A 65-year-old patient underwent pericardiocentesis for cardiac tamponade after radiofrequency ablation for ventricular tachycardia. Subsequent to stabilization, the patient developed pneumopericardium, which was detected in the catheterization laboratory and managed successfully by pericardial aspiration.

Pneumopericardium is rare and has been reported secondary to chest trauma. We report a case of tension pneumopericardium occurring during double-lung transplantation, where intraoperative transoesophageal echocardiography first showed a hypokinetic left ventricle and a few minutes later a compression of its anterolateral portion due to pneumopericardium. Although the pericardium was opened, left ventricular function remained depressed, necessitating extracorporeal membrane oxygenation, which was withdrawn after 48 h of assistance when left ventricular function had recovered. The patient was extubated on the seventh postoperative day but died of multiorgan failure on the 64 th postoperative day.

The pericardium provides an enclosed lubricated space for the beating heart and functions to fix the heart in the chest cavity relative to adjacent organs. Pericardial pathophysiology is often manifested in a spectrum of distinct cardiac and systemic disease states. The pericardial response to injury typically involves a spectrum of inflammation with both acute and chronic features and/or fluid accumulation. Recent advances in imaging methods have refined the diagnosis and therapy of pericardial disease. This article presents the anatomy and physiology of pericardial disease and the clinical approach for diagnosis and treatment., (Copyright © 2012. Published by Mosby, Inc.)

Pneumopericardium is a rare but serious finding. It may indicate severe chest trauma and be associated with tracheobronchial and oesophageal injuries. On the other hand, oesophageal rupture such as Boerhaave's syndrome may also be accompanied by pneumopericardium. A case of spontaneous pneumopericardium and pneumomediastinum after alcohol-induced emesis is reported. Tracheal, bronchial, and oesophageal injury were excluded by radiology and endoscopy. Interstitial lung emphysema is discussed as the pathogenesis.

We describe a newborn with acute respiratory distress syndrome, subjected to mechanical ventilatory assistance with high level of peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP), who developed cardiac tamponade due to pneumopericardium. Tension pneumopericardium produces the same physiological derangement as cardiac tamponade secondary to accumulated blood or other fluids. This life-threatening complication demands immediate diagnosis and treatment., (Copyright 2006 S. Karger AG, Basel.)

Spontaneous idiopathic pneumopericardium (SIPP) in young subjects is a rare disorder since, apart from the case described here, only 28 cases have been reported in the literature. It occurs mainly in young adults. The physiopathology of the disorder involves alveolar rupture, as described by Macklin. The symptoms of SIPP are dominated by chest pain, which usually develops suddenly and is combined with dyspnea. Clinical examination is not very helpful, cardiac auscultation detects either pericardial rubbing or a more suggestive metallic sound. Recovery usually occurs without treatment, but there is a risk of long-term recurrence. An unusual complication to be feared is aerial tamponade, which may be life-threatening and calls for emergency draining. The treatment of SIPP involves strict bed-rest, symptomatic treatment of the pain and clinical monitoring.

A case history of a patient with unusual injuries following blunt thoracic trauma is presented. There was a pneumopericardium, bilateral tension pneumothoraces and rupture of the thoracic trachea, and the shock lung syndrome developed. Some points which arose in the management of the case are discussed, and it is pointed out that such injuries may be missed and must be considered in all patients with thoracic trauma especially those who do not improve with routine therapy.

One case of "idiopathic pneumoperitoneum" following closed thoraco abdominal injury, primitively associated with a pneumopericardium is reported. No etiology was discovered about these two aeric effusions. Also it was interesting to compare this experience with literature to know frequency of such association; physiopathologic mechanism responsible and management of the described other cases.

A case with pneumopericardium and pneumomediastinum produced by a bronchial foreign body (pieces of a nut) is reported. The pathomechanism is discussed: In state of check valve the bronchial foreign body produces an interstitial emphysema by rupture of the alveolar membranes in the overinflated lung. The interstitial air travels along the sheaths of the pulmonary blood vessels to the root of the lung, to mediastinum, and to pericardium. In state of stop valve, depending on the inflammatory swelling of the mucosa, the affected lung becomes atelectatic. After removing the foreign body air passage will be free. Other therapeutic measures are not necessary.

The hemodynamics of progressive pneumopericardium were studied in 6 anesthetized healthy dogs (with intact thorax). Heart rate, cardiac output, and pericardial and intravascular pressures were recorded. Pressures were measured in the pericardial space by means of a percutaneously introduced, air-filled catheter, and in the right atrium, right ventricle, left atrium, left ventricle, pulmonary artery, and aorta by means of fluid-filled catheters. The gradual increase in mean pericardial pressure up to 11 +/- 2 mm of Hg was associated with increases in heart rate and mean right atrial, mean left atrial, right ventricular end-diastolic, and left ventricular end-diastolic pressures and with decreases in cardiac output and stroke volume, with no change in left ventricular systolic and mean aortic pressures. Critical cardiac tamponade occurred at a pericardial pressure of 12.2 +/- 2.8 mm of Hg, which was produced by 8.7 +/- 1.9 cm3 air/kg of body weight. This was characterized by a sudden marked decrease in heart rate, cardiac output, stroke volume, left ventricular systolic pressure, and mean aortic pressure, and equilibration of mean right atrial, mean left atrial, right ventricular end-diastolic, left ventricular end-diastolic, and pulmonary artery diastolic pressures. These hemodynamic changes were similar to those of experimental pericardial effusion.

We report the induction of pneumopericardium by forced coughing during coronary arteriography in a 31-year-old male with anterior chest pain. The patient had no underlying disease and pneumopericardium could be reproduced by forced coughing. To our knowledge, there has been no report in the literature of pneumopericardium induced during coronary arteriography.

Case reports of all infants admitted to the NICU from 1971 to 1982, who developed a pneumopericardium (PPC) while receiving intermittent positive-pressure ventilation, were reviewed in order to determine those variables of assisted ventilation associated with the occurrence of PPC. Of 19 infants seen during the 11-yr period, 16 had respiratory distress syndrome (RDS) and 3 had other forms of severe pulmonary disease. Mean birth weight was 1720 g, gestational age 32 wk, and age at occurrence 59 h. Peak inspiratory pressure (PIP) (mean 32 cm H2O), inspiratory time (IT) (0.74 sec), and mean airway pressure (MAP) (mean 17 cm H2O) were significantly elevated just before occurrence of the PPC, compared with values 6 h previously. PEEP (mean 3.8 cm H2O), ventilator rate (mean 40/min), PaCO2 (mean 41 torr), P(A-a)O2 (mean 443 torr), and inspired oxygen concentration (FIO2, 0.77) were unchanged. MAP was significantly lower (mean 11 cm H2O) 6 h after the event compared with just before (mean 14 cm H2O) in infants who died, suggesting that lowering airway pressure does not improve survival. These data indicate that high PIP, prolonged IT and elevated MAP are associated with the development of PPC. MAP provides a composite of pressure transmitted to the airways and may be the more useful index in preventing barotrauma and pulmonary air leak.