BENIGN PNEUMOPERICARDIUM AND TAMPONADE

A 49-year-old obese female was admitted for acute onset pleuritic ches t pain. Previous history was significant for surgical correction of a lower esophageal ring. Echocardiography revealed a pericardial effusio n, which resolved with steriods. One week later, the patient complaine d of similar symptoms. Physical examination was consistent with tampon ade, while a Hammond crunch was noted over the sternum. Chest x-ray re vealed a pneumopericardium. Operative findings consisted of an intrath oracic stomach, a greater curvature ulcer that had perforated the peri cardium and a mediastinal abscess. A pericardial window was created, a drain was placed and the perforated ulcer was repaired. Postoperative course was complicated by fever and gastrointestinal bleeding. The pa tient died suddenly on the 30th postoperative day. Autopsy revealed a massive pulmonary embolus, bleeding esophageal ulcer, healed gastric u lcer and serofibrinous pericarditis. This case illustrates that, while the immediate treatment of tension pyopneumopericardium is usually su ccessful, postoperative mortality remains elevated.