Author Affiliation: Department of Thoracic Surgery, Poznań University of Medical Sciences, Poland.
A 63-year-old woman who had a left hemicolectomy 3 years ago (secondary to adenocarcinoma of splenic curvature of colon [T4N1, Dukes C2]) presented with dyspnea, retrosternal pain, and low-grade fever for a few days. A physical examination revealed tachycardia and hypotension. Auscultatory percussion over the heart was tympanic, and metallic splashing sounds synchronous with heart beats could be heard as well. A chest radiograph showed an area of radiolucency on both sides of the heart and a poorly visible, narrow radiolucent area extending toward the colon (Figure 1).
Figure 1. Chest radiograph showing air in the pericardial cavity of a 63-year-old woman.
A. Acute pericarditis
B. Gastropericardial fistula
C. Malignant pericardial effusion
D. Diaphragmatic hernia
Gabryel P, Gąsiorowski Ł, Gałęcki B, Dyszkiewicz W. Image of the Month—Quiz Case. JAMA Surg. 2013;148(2):205-205. doi:10.1001/jamasurgery.2013.418a