Clinical Presentation

30-year-old man who sustained multiple stab wounds to his chest

Radiologic Findings

None

Discussion

Background

Pneumopericardium is defined as air within the pericardial sac. Post-traumatic pneumopericardium is rare; however, its presence is likely associated with an underlying cardiac injury. Pericardial and cardiac injuries are more commonly associated with penetrating as opposed to blunt trauma and result from direct violation of the pericardium and/or myocardium. Although less common with blunt thoracic trauma, injuries may occur following severe blows to the anterior chest. Such injuries may be complicated by cardiac contusion, cardiac rupture, valvular injuries, coronary artery injuries, conducting system injuries, hemopericardium, and cardiac tamponade.

Etiology

Pneumopericardium may result from cardiac or mediastinal surgery, penetrating or blunt trauma, infectious pericarditis with gas-producing organisms, and a fistulous communication between the pericardium and an adjacent air-containing organ (i.e., stomach or esophagus). Pneumopericardium secondary to blunt chest trauma is generally due to one of three mechanisms: (1) air extension along pulmonary venous perivascular sheaths from ruptured alveoli to the pericardium, (2) pneumothorax associated with pleuropericardial tear. or (3) direct tracheobronchial-pericardial communication.

Clinical Findings

Cardiac contusion