Pneumopericardium in a patient with pulmonary tuberculosis: A case report and review of literature

Abstract

Pneumopericardium is defined as the presence of gas in pericardial space. In adults, it may be seen in the context with severe blunt or penetrating chest trauma. The incidence of pneumopericardium is 0.8% and nearly 60% of the cases are due to trauma. A 55-year-old female admitted with the complaints of cough, breathlessness, left-sided chest pain – a case of left secondary spontaneous pneumothorax with the Intercostal drainage tube (ICD) in situ, her computed tomography image revealed pneumopericardium, residual left pneumothorax with ICD tube in the subcutaneous plane. After successful repositioning of ICD tube, pneumopericardium and left pneumothorax both got resolved. Her sputum examination results were positive for Mycobacterium tuberculosis, and she started on Anti-tubercular treatment (ATT). Her condition was gradually improved; the ICD tube was removed and discharged from the hospital in stable condition. On follow-up, both clinical and radiological improvement was there. A severe bout of cough (Macklin effect) and fistulous communication could be the two possible mechanisms for spontaneous pneumopericardium. Treatment of the underlying condition will resolve the pneumopericardium.

Keywords

• pneumopericardium
• pulmonary tuberculosis
• mechanism
• macklin effect
• diagnosis
• management