Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023, 167(1):91-94 | DOI: 10.5507/bp.2021.060

Tension pneumopericardium in a polytrauma patient

Jana Pometlova^{1, 2}, Petr Handlos³, Renata Jecminkova^{4, 5}, Miroslav Kitka⁶, Pavel Koscielnik⁷

¹ Institute of Emergency Medicine, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava-Vítkovice, Czech Republic

² Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic

³ Institute of Forensic Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic

⁴ Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava-Vítkovice, Czech Republic

⁵ Accident and Emergency Department, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic

⁶ Faculty of Medicine and Clinic of Trauma Surgery, Pavel Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic

⁷ Department of Radiology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic

Introduction: Tension pneumopericardium is a life-threatening condition, manifesting most commonly as hemodynamic instability caused by cardiac tamponade. Reduced cardiac output and blood pressure can lead to difficulties in the detection of arterial bleeding from associated injuries while the increased venous pressure can increase the rate of bleeding.

Case report: This is the case of a patient after a car accident, with bilateral serial fractures, bilateral pulmonary contusion, bilateral pneumothorax, emphysema of the neck and chest, pneumomediastinum and pneumopericardium, and other injuries. During treatment, the patient developed a gradually progressing hemodynamic instability, resulting in pulseless electrical activity. Further progression of the case is detailed in the paper.

Conclusions: Tension pneumopericardium is a rare complication of a high-energy blunt thoracic trauma that manifests through hemodynamic instability. Its treatment requires early diagnosis and immediate decompression of the pericardial cavity, which should, where possible, be performed even before putting the patient on mechanical ventilation as ventilation bears a high risk of worsening the pneumopericardium due to the increased air pressure in the lungs. During diagnosis and treatment of associated injuries, we must bear in mind that the hemodynamic changes caused by pneumopericardium can mask typical signs of such injuries.

Keywords: pneumopericardium, trauma, mechanical ventilation, hemodynamic instability

Received: June 7, 2021; Revised: October 11, 2021; Accepted: October 19, 2021; Prepublished online: November 5, 2021; Published: March 15, 2023  Show citation