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    "titulo" => "Tension pneumopericardium secondary to esophageal-pericardial fistula"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Transthoracic echocardiogram showing air bubles swirling in the pericardial space &#40;arrow&#41;&#46; &#40;B&#41; Chest X ray demostrating air along the left and right borders of the heart &#40;arrows&#41;&#46; &#40;C&#41; Three-dimensional reconstruction of the airway and &#40;D&#41; chest tomography showing a big buble of air in the mediastinum &#40;arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 64-year-old male with a past medical history of diabetes&#44; hypertension and esophageal myotomy for esophageal diverticulum four months ago&#46; He underwent a Nissen fundoplication due to diverticulum recurrence&#46; On his second post-operatory day&#44; he presented chest pain and fever associated with a lower respiratory tract infection treated with levofloxacin&#46; A routine esophagogram&#44; performed four days postoperatively&#44; demonstrated no leakages &#40;<a class="elsevierStyleCrossRef" href="#sec0015">video S1</a>&#41;&#46; On his seventh postoperative day&#44; he reported an intense stabbing chest pain&#59; a bedside transthoracic echocardiogram demonstrated small air bubbles swirling in the pericardial space suggestive of pneumopericardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and <a class="elsevierStyleCrossRef" href="#sec0015">video S2</a>&#41;&#46; On the chest X-ray&#44; a radiolucent space along the left and right borders of the heart confirmed the presence of air in the pericardial sac &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; A subsequent chest tomography and three-dimensional reconstruction of the airway revealed the presence of a large bubble of air in the pericardium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D&#41;&#46; The patient quickly deteriorated presenting hypotension and shock nonresponsive to vasoactive agents&#46; He underwent an emergent pericardial window improving his clinical status&#46; As a surgical finding&#44; an esophageal-pericardial fistula was found&#46; This was later confirmed with methylene blue&#44; given orally and then appearing in the drainage tube&#46; A subsequent surgical intervention for fistula repair using a serosal patch took place&#46; Thereafter&#44; the patient&#39;s circumstances were complicated by purulent mediastinitis&#46; He was treated with broad spectrum antibiotics and surgical debridement&#46; Unfortunately&#44; the patient died after two months of medical efforts&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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