Recurrent tension pneumopericardium in a term neonate on high-frequency ventilation: Early recognition and percutaneous management

Abstract

Background: Air leak syndrome (ALS) can be seen in sick neonates on positive pressure ventilation. Tension pneumopericardium is uncommon, but life-threatening if not promptly identified and treated. Needle decompression can be life-saving. Recurrent tension pneumopericardium is difficult to treat and ideally indicates the placement of a pericardial drain under fluoroscopic guidance. We describe an alternative technique of percutaneous drain placement using intrapericardial saline infusion when the transport of the neonate to a catherization laboratory was not feasible. Clinical Description: A neonate with hyaline membrane disease and persistent pulmonary hypertension of new-born on high-frequency mechanical ventilation developed recurrent tension pneumopericardium that caused hemodynamic compromise. Management: Emergency needle decompression was performed twice. Further recurrence necessitated pericardial drain placement under echocardiographic guidance. Rapid exit of air from the pericardial cavity made advancement of the guidewire challenging. A small amount of sterile saline was injected in the pericardial space to assist advancement following which placement of the pericardial drain was successful. Subsequently, the neonate had an uneventful course and was discharged after 3 weeks. Conclusion: Prompt recognition and management of ALS can be life-saving. Urgent needle decompression and pericardial drain placement can be performed under fluoroscopic (ideally) or echocardiographic guidance by trained personnel. Instillation of saline in the pericardial space may assist with pericardial drain placement.

Keywords

• pericardial drain
• positive pressure ventilation respiratory distress
• seldinger technique