"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.
Pfaff C, Hunter TB, Silverstein ME, Freundlich IM. Pneumopericardium Secondary to a Fistula: Communication Between Pericardium and Subphrenic-Colonic Abscess. JAMA. 1976;235(23):2522–2523. doi:10.1001/jama.1976.03260490040021
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: