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Netherlands Heart Journal

, Volume 25, Issue 5, pp 348–349 | Cite as

Cardiac tamponade due to pyopneumopericardium from malignant bronchopericardial fistula

  • T. M. FrisoliEmail author
  • T. Jain
  • T. Swadia
  • X. Hong
  • M. Guerrero
Open Access
Heart Beat

Keywords

Staphylococcus Aureus Trauma Patient Lung Adenocarcinoma Newborn Infant Pericardial Effusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
A 71-year-old female with lung adenocarcinoma underwent surveillance PET/CT, which revealed new central necrotic cavitation of a preexisting left lower lobe mass, with communication between this air-filled cavity and the left mainstem bronchus, as well as pericardial effusion with large pneumopericardium, consistent with malignant bronchopericardial fistula (Fig. 1). Echocardiography and physical examination confirmed tamponade. Bronchoscopic debulking showed a necrotic tumour cavity. During pericardiocentesis, air in the pericardial space was conspicuous fluoroscopically (Video 1). Intra-pericardial pressure was 11 mm Hg, 1500 ml of seropurulent fluid was removed. Fluid cultures were positive for Staphylococcus aureus. Her rest dyspnoea improved and she was discharged to hospice care.
Fig. 1

a, b CT demonstrates abnormal communication between the air-containing core of the necrotic lung mass with the left mainstem bronchus (arrows), as well as a large pneumopericardium (wider arrowheads) which is anterior to the heart. c, d PET CT demonstrates intense hypermetabolic air-containing cavitary large soft tissue mass in the left lower lobe (wider arrowhead), and moderate to intense hypermetabolic activity in the fibrous and parietal pericardium (arrows), which may represent infection and/or malignancy

Pneumopericardium is known to cause cardiac tamponade [1] in trauma patients or newborn infants requiring positive pressure ventilation. Fistulas such as between the oesophagus, stomach, or lung [2, 3] and pericardium have been reported. The unique images and video presented are illustrative of this interesting disease entity.

Notes

Conflict of interest

T. M. Frisoli, T. Jain, T. Swadia, X. Hong and M. Guerrero declare that they have no competing interests.

Supplementary material

Video 1: Pneumopericardium as seen on fluoroscopy just prior to pericardiocentesis

References

  1. 1.
    Cummings RG, Wesly RL, Adams DH, Lowe JE. Pneumopericardium resulting in cardiac tamponade. Ann Thorac Surg. 1984;37:511–8.CrossRefPubMedGoogle Scholar
  2. 2.
    George LD, David N, Omrani A, Davies R. Bronchogenic carcinoma presenting as a bronchopericardial fistula. Int J Clin Pract. 1999;53:147–8.PubMedGoogle Scholar
  3. 3.
    Harris RD, Kostiner AI. Pneumopericardium associated with bronchogenic carcinoma. Chest. 1975;67:115–6.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2017

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  • T. M. Frisoli
    • 1
    Email author
  • T. Jain
    • 1
  • T. Swadia
    • 2
  • X. Hong
    • 3
  • M. Guerrero
    • 4
  1. 1.Department of CardiologyHenry Ford HospitalDetroitUSA
  2. 2.Department of Cardiology, Michigan HeartSt Joseph Mercy Health SystemLivoniaUSA
  3. 3.Department of RadiologyHenry Ford HospitalDetroitUSA
  4. 4.Department of Cardiology, Evanston HospitalNorth Shore University Health SystemEvanstonUSA

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