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Background: This case report highlights a rare iatrogenic complication of pericardiocentesis and discusses its clinical management. In most cases, pneumopericardium is usually self-limiting and does not require any specific treatment. Therefore, a timely diagnosis and urgent treatment are required. Currently, there are only a few reports regarding pneumopericardium following therapeutic pericardiocentesis.

Case Presentation: We present a case of an 81-year-old woman who developed pneumopericardium following pericardiocentesis for pericardial effusion, a rare association reported in the literature.

Conclusion: Pneumopericardium may develop iatrogenically after Pericardiocentesis. Attention should be paid to the puncture site and angle during pericardial puncture, especially in weak patients.

Keywords: pericardial effusion, pericardiocentesis, pneumopericardium, emergency medicine, bedside ultrasonography

What is new: This clinical case analysis aims to summarize the etiology, clinical features, diagnosis, treatment methods, and complications of pneumopericardium to improve understanding of this rare condition.

 Background: Atrial myxomas are the rare slow-growing tumors of the heart and are often found in the left atrium; they most commonly present with symptoms of thromboembolic disease and have rarely been associated with respiratory symptoms.

 Case Presentation: We present the case of a 71-year-old woman who attended the emergency department with a 72-hour history of shortness of breath, a cough, and wheeze. She had been diagnosed with chronic obstructive pulmonary disease in the community recently but had never had any spirometry testing. She was treated for an exacerbation of airways disease with nebulized bronchodilators, steroids, and antibiotics. She deteriorated after 24 hours to the point of requiring intubation and ventilation, despite escalating her to extensive bronchodilator therapy she did not improve and the wheeze was persistent. Subsequently, an echocardiogram was performed at the bedside which revealed a large left atrial mass which led to discussion with local cardiologists and cardiothoracic surgeons. The mass was resected and confirmed to be an atrial myxoma on histology. The patient had a good recovery and, when seen in the follow-up clinic, reported that her breathing had returned to normal, with no wheeze present.

 Conclusion: This case highlights the dangers of making a premature diagnostic judgment when a patient presents with a pre existing diagnosis, as in our case it was considering an alternative pathology that led to the final diagnosis. It also demonstrates the importance of considering cardiac disease as a differential for wheeze and using echocardiography in the assessment of the patient with respiratory failure.