Pneumopericardial tamponade resulting from a spontaneous gastropericardial fistula

• Published in: Catheterization and cardiovascular interventions Vol. 73; no. 5; pp. 666 - 668
• Main Authors: Bruhl, Steven R., Lanka, Kiranmayee, Colyer, William R.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2009
• Subjects: cardiac catheterization; Cardiac Tamponade - diagnostic imaging; Cardiac Tamponade - etiology; Cardiac Tamponade - surgery; Electrocardiography; Esophagectomy; Fistula - complications; Fistula - diagnostic imaging; Fistula - etiology; Fistula - surgery; Fluoroscopy; Gastrectomy; Gastric Fistula - complications; Gastric Fistula - diagnostic imaging; Gastric Fistula - etiology; Gastric Fistula - surgery; Heart Diseases - complications; Heart Diseases - diagnostic imaging; Heart Diseases - etiology; Heart Diseases - surgery; Hernia, Hiatal - complications; hiatal hernia; Humans; Male; Middle Aged; Peptic Ulcer Perforation - complications; Pneumopericardium - diagnostic imaging; Pneumopericardium - etiology; Pneumopericardium - surgery; Stomach Ulcer - complications; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.21947

Pneumopericardium is a rare but serious cause of morbidity and mortality. Untreated, it can lead to cardiac tamponade and thus must be promptly identified to treat the underlying etiology. Here, we report a case of spontaneous pneumopericardium secondary to gastric ulcer perforation in association with a hiatal hernia. The diagnosis of pneumopericardium was first made under fluoroscopy during cardiac catheterization and a follow‐up CT of the chest revealed a gastropericardial fistula as the initiating event. The patient underwent emergent thoracotomy and partial esophagogastrectomy which eventually resulted in a full recovery and discharge on postoperative day 19. Our unique experience with this rare and often fatal disease suggests that early diagnosis combined with an early and aggressive surgical strategy is critical for minimizing morbidity and mortality. © 2008 Wiley‐Liss, Inc.