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A 6-month-old girl presented with respiratory failure due to respiratory infection requiring intubation.
Her pre-intubation chest x-ray is shown in Figure, A. Thirty minutes subsequently, the patient developed an acute syndrome characterized
by difficulty to ventilate, hypotension, and bradycardia. A repeat chest x-ray revealed
pneumopericardium without associated pneumothorax (Fig, B). Emergent pericardiocentesis and placement of a pericardial drain resulted in immediate
return of normal sinus rhythm, and improvement in blood pressure and oxygenation.
A repeat chest x-ray demonstrated resolution of the pneumopericardium (Fig, C). Bronchoscopy was performed during the hospital course with no evidence of tracheobronchial
injury and the pericardial drain was removed.
FigureThree serial chest radiographs (CXR) are presented to document the patient's clinical
course. (A) Patient's admission CXR to the emergency department, which shows a right sided pulmonary
infiltrate as the probable cause of the infants presenting respiratory distress. (B) The development of pneumopericardium (black arrows) after endotracheal intubation. (C) CXR taken after pericardiocentesis and insertion of a pericardial drain (arrows).
