Pneumopericardium following penetrating chest injuries
D. Demetriades, D. Charalambides, D. Pantanowitz and M. Lakhoo
Department of Surgery, Baragwanath Hospital, Johannesburg, Republic of South Africa.
The presence of pneumopericardium following penetrating injuries of the
chest is highly suggestive of a cardiac injury. For this reason, it is
generally considered that its presence should be an indication for surgery.
In the present study 20 patients with pneumopericardium were selected for
conservative treatment. All patients were closely observed by means of
clinical examination, serial chest roentgenography, electrocardiography,
and Doppler echocardiography. In five patients the electrocardiogram showed
pericarditis, and in three patients the echocardiogram demonstrated small
pericardial effusions. One patient developed tension pneumopericardium 36
hours after admission and required surgical intervention. The remaining 19
patients had an uneventful recovery. We suggest that the presence of a
pneumopericardium following penetrating chest trauma is not an absolute
indication for surgery. Electrocardiographic and echographic studies may
help in the selection of patients for conservative treatment; but the final
decision should be made on the basis of clinical signs and symptoms.
