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June 7, 1976

Pneumopericardium Secondary to a Fistula: Communication Between Pericardium and Subphrenic-Colonic Abscess

Author Affiliations

From the departments of radiology (Drs Pfaff, Hunter, and Freundlich) and surgery (Dr Silverstein), the University of Arizona Medical Center, Tucson.

JAMA. 1976;235(23):2522-2523. doi:10.1001/jama.1976.03260490040021

"SPONTANEOUS" pneumopericardium is a rarely encountered entity.1-3 The case reported here is unusual, as it was secondary to a fistulous communication with a subphrenic-colonic abscess.

Report of a Case  A 65-year-old woman complained of diarrhea, fever, and rapidly progressing debilitation for one week. The only available past history was the report of an inoperable malignant neoplasm of the colon, diagnosed six months earlier in another country by barium enema. She was dyspneic and severely dehydrated, and she had atrial fibrillation and a palpable abdominal mass in the left upper quadrant. An admission chest roentgenogram showed a large pneumopericardium (Fig 1). Pericardiocentesis yielded approximately 300 cc of gas and 50 ml of thick, brown liquid with a fecal odor.Emergency extraperitoneal subcostal exploration disclosed a large left anterior subphrenic abscess that communicated with the pericardial cavity through an opening 1 cm in diameter in the central tendon of the diaphragm.