Image in Cardiology
The heart in an air bubble
O coração numa bolha de ar
Sara Moura-Ferreira
, Anabela Tavares, Dinis Martins
Corresponding author
Cardiology Department, Divino Espírito Santo Hospital, Ponta Delgada, Azores, Portugal
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His medical history included poorly differentiated stage IV epidermoid lung carcinoma, under palliative chemotherapy. On admission, he was hemodynamically stable, with no signs of respiratory distress. There were no significant abnormalities on laboratory or blood gas analysis. The chest X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B) showed a radiolucent band of air partially surrounding the heart. Thoracic computed tomography (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D) confirmed the presence of pneumopericardium. Air in the pericardial space made acquisition of transthoracic echocardiographic images impossible (no echocardiographic window). The patient did not present clinical manifestations of cardiac tamponade, so conservative treatment was decided on. He improved clinically and was safely discharged to the outpatient palliative care clinic after one week. At one-month follow-up, the patient was asymptomatic with no evidence of residual pneumopericardium on the chest X-ray.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Pneumopericardium in patients with lung cancer is extremely rare. It is thought to be caused by formation of a bronchopericardial fistula by direct pericardial invasion of the tumoral mass (the most likely cause of pneumopericardium in our patient), or iatrogenic trauma due to invasive procedures, or rupture of a bulla into the pericardium through a necrotic focus. In stable patients, pneumopericardium can be treated conservatively, although close clinical monitoring is advised.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This case report shows a rare but potentially life-threatening condition, diagnosed in the emergency department with a chest X-ray, which highlights the value in clinical practice of recognizing classic images in simple, inexpensive and readily available exams.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-09" "fechaAceptado" => "2018-08-07" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1213 "Ancho" => 1501 "Tamanyo" => 162735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray on admission showing a radiolucent band of air partially surrounding the heart (arrows) consistent with pneumopericardium, in posteroanterior (A) and lateral (B) views; chest computed tomography scan confirming the presence of pneumopericardium (arrows), in coronal (C) and axial (D) views.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003800000006/v1_201909140841/S2174204919301771/v1_201909140841/en/main.assets" "Apartado" => array:4 [ "identificador" => "28321" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Image in Cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003800000006/v1_201909140841/S2174204919301771/v1_201909140841/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919301771?idApp=UINPBA00004E" ]
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