Hydropneumopericardium

Case contributed by Rodney Strahan

Presentation

Presented with breathlessness and clinically was in cardiac failure.

Patient Data

Age: 25 years
Gender: Male
x_ray

A large pericardial effusion was diagnosed by ultrasound and a pericardial tap was performed under ultrasound guidance. The air was inadvertently introduced during the procedure. 

x_ray

Initial chest imaging demonstrated bilateral pleural effusions and a globular enlarged cardiac shadow. Differential for the cardiac shadow on plain film would include cardiomegaly, cardiomyopathy or pericardial effusion. A pericardial effusion can be easily diagnosed by ultrasound.

Case Discussion

Gas can be inadvertently introduced during a pericardial or pleural effusion tap. Testing of the pericardial fluid demonstrated an exudate, not a transudate. In this setting, with tuberculosis endemic, treatment was given and the pericardial effusion resolved.

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