Case Image 
Kauser Rehana 1, Muhammad Mudassir Shafiq 2 

Department of Pulmonology, Pakistan Institute of Medical Sciences Islamabad. 
 

 

 

 

 

 

 

 
Figure 1:A) Chest Xray PA view showing air shadow in cardiac area representing pneumopericardium. B) CT scan chest 
with contrast coronalview showing rim of air around whole heart shadow. C) axial view showing thick rim of air 

surrounding cardiac shadow. D) sagittal view showing pneumopericardium. 

 

R e f e r e n c e s  

1. Lee YJ, Jin SW, Jang SH, Jang YS, Lee EK, Kim YJ, Lee 
MY, Park JC, Rho TH, Kim JH, Hong SJ, Choi KB. A case of 
spontaneous pneumomediastinum and pneumopericardium 
in a young adult. Korean J Intern Med. 2001;16(3):205–209. 

2. Mullens W, Dupont M, De Raedt H. Pneumopericardium 
after pericardiocentesis. Int J Cardiol. 2007;118(2): e57.  

3. Choi WH, Hwang YM, Park MY, Lee SJ, Lee HY, Kim SW, 
Jun BY, Min JS, Shin WS, Lee JM, Koh YS, Jeon HK, 

Chung WS, Seung KB. Pneumopericardium as a 
complication of pericardiocentesis. Korean Circ J. 
2011;41(5):280–282. 

4. Brander L, Ramsay D, Dreier D, Peter M, Graeni R. 
Continuous left hemidiaphragm sign revisited: a case of 
spontaneous pneumopericardium and literature review. 
Heart. 2002;88(4): e5 

A 13 years old girl referred from Rawalpindi institute of Cardiology, where she was admitted with a diagnosis of pericardial effusion that was 

exudative and predominantly lymphocytic. Pigtail catheter was inserted for pericardiocentesis and after drainage of 1 liter she was shifted to 

Pulmonolgy PIMS with suspicion of tuberculous pericardial effusion and she was on ATT with steroid at that time. Cardiology team was 

consulted here; catheter was removed as no evidence of collection on Echocardiography. Post extubation X-Ray chest showed air shadow in 

mediastinum. CT scan chest was done that revealed mediastinal widening and proved this shadow to be pneumopericardium, likely traumatic 

keeping history in view. She had palpable cervical lymph nodes, biopsy was planned. 

Pneumopericardium common causes are spontaneous Pneumopericardium without underlying cause in healthy adult or trauma1. 

Pneumopericardium after pericardiocentesis is even rarer and has been attributed either to an air leakage to the pericardial drainage system 

or to a direct pleuro-pericardial communication.2-4 Latrogenic pneumopericardium requires no specific therapy most of the time but in some 

patients, life-threatening complications (pericardial tamponade) can occur and require urgent recognition and immediate managements.3,4 It is 

relatively easy to diagnose pneumopericardium by chest radiographs which shows lucent outline separating the pericardium from the heart.3 

C A S E  I M A G E