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OpenAthens Shibboleth
Special Feature
Feb 2013

Image of the Month—Quiz Case

Author Affiliations

Author Affiliation: Department of Thoracic Surgery, Poznań University of Medical Sciences, Poland.

JAMA Surg. 2013;148(2):205-205. doi:10.1001/jamasurgery.2013.418a

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).

Image not available

Figure 1. Chest radiograph showing air in the pericardial cavity of a 63-year-old woman.

What Is the Diagnosis?

A.  Acute pericarditis

B.  Gastropericardial fistula

C.  Malignant pericardial effusion

D.  Diaphragmatic hernia