Pneumopericardium

Associate Editor-In-Chief:

Overview
Pneumopericardium is a medical condition where air enters the pericardial cavity and a well-recognized clinical and radiologic entity. It can be congenital, or introduced by a wound.

Differential Diagnosis of Underlying Causes

 * Congenital diseases
 * Surgery
 * Penetrating trauma
 * Blunt trauma (rare)
 * Infectious pericarditis with gas-producing organisms
 * Fistula formation between the pericardium and an adjacent air-containing organ (i.e. stomach or esophagus))

Chest X-Ray

 * The heart partially or completely surrounded by air, with the pericardium sharply outlined by air density on either side.
 * Pneumopericardium can usually be distinguished from pneumomediastinum, since air in the pericardial sac should not rise above the anatomic limits of the pericardial reflexion on the proximal great vascular pedicle. Also on radiographs obtained with the patient in the decubitus position, air in the pericardial sac will shift immediately, while air in the mediastinum will not shift in a short interval between films.
 * Occasionally, it may not be possible to distinguish pneumopenicardium from pneumomediastinum on plain film.