Pitfalls in Diagnosing a Tension Pneumopericardium—A Case Report

A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable;however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.

Subcutaneous Emphysema Associated with Pneumomediastinum and Complicated Pneumopericardium in a 14-Month-Old Infant

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Gastropericardial fistula: a case report

Rationale: Gastropericardial fistula is a rare condition in which the patient presented with chest pain, dyspnea, tachycardia, pneumo/hydropericardium, or pericarditis. Alcohol intake or previous history of gastroesophageal surgery made the patient susceptible to fistula formation. Patient concerns: An 80-year-old male complained of sudden onset of dyspnea and respiratory distress. Nausea, hematemesis, and constipation were noted on clinical examination. Diagnosis: Herniation of the gastric fundus and massive pneumopericardium due to formation of fistula in the lesser curvature. Interventions: Urgent surgery was performed. Outcomes: The patient was discharged without any complication. Lessons: Although the lethal form of this condition is rare, gastroepicardial fistula should be included in the differential diagnosis workup of cases with stomach cardia and fundus ulceration.

妇科腹腔镜手术不同气腹压及不同气腹时段的临床观察

目的观察妇科腹腔镜手术在不同气腹压及气腹不同时段对血流动力学、呼气末二氧化碳分压和气道压的影响。方法选择60例ASAⅠ级行妇科腹腔镜手术患者.随机分为两组,分别为气腹压1.3 kPa和1.9 kPa,监测并记录麻醉前(T_0),插管后即刻(T_1).气腹前(T_2),气腹平卧后5 min(T_3),气腹特定体位后5 min(T_4)、10 min(T_5)、20 min(T_6)、30 min(T_7),术毕放气后5 min(T_8)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、ST段值、气道压(Paw)、呼气末二氧化碳分压(P_(ET)CO_2)。结果两组患者气腹后T_3、T_4、T_5时段SBP、DBP、MAP与T_0时段相比显著升高(P<0.01),但升高的幅度呈下降趋势,T_6时段开始血压下降至术毕。HR在整个气腹期间与T_0相比下降显著(P<0.01)。ST段值在上述期间则向上抬高(P<0.01),而上述指征对应时段两组间差异无统计学意义(P>0.05),但Paw和P_(ET)CO_2组间、组内气腹前后差异均有统计学意义(P<0.05)。结论妇科腹腔镜手术在气腹压(IAP)为1.3 kPa和1.9 kPa时对血流动力学的影响无明显差异,但对呼气末二氧化碳分压和气道压的影响差异有统计学意义。

A jejunopericardial fistula 14 years after surgery for gastric cancer

Afistula between pericardium and its adjacent structures is an extremely rare and usually fatal complication with the esophagus and stomach most frequently involved.In this report, we present the rare case of a patient who developed a jejunopericardial fistula after surgery for gastric cancer and intraperitoneal chemotherapy with placement of Port-A-Cath 14 years ago.

严重多发伤合并心包积气微创治疗

在多发伤的治疗过程中,基于创伤复合手术室的伤控手术策略和微创治疗技术可以最快地控制原发伤恶化,实施更准确、有效、微创的治疗,提高患者的生存率和预后。本院于2021年12月收治了1例严重多发伤合并心包积气患者,基于上述创伤急救理念采取救治措施,取得了满意的疗效。分析汇总后,以期为临床治疗提供参考。

新生儿心包积气诊治分析并文献复习

目的探讨新生儿心包积气的临床特征及治疗经过,并进行文献复习。方法选择2018年4月21日,于四川省妇幼保健院经剖宫产术分娩后约10 min时,出现气促、呻吟、面色青紫,立即在吸氧下转入四川省妇幼保健院新生儿科治疗的1例生后1 h+22 min心包积气新生儿为研究对象。采用回顾性分析方法,收集该例新生儿的临床病例资料,对其临床特征和诊治经过进行总结。本研究对新生儿心包积气文献进行复习时,设定的文献检索策略为:以"新生儿""心包积气""neonate"及"pneumopericardium"为中、英文关键词,在PubMed数据库、Wily Online Library、万方数据知识服务平台、维普中文科技期刊数据库中,检索新生儿心包积气相关文献,检索时间设定为2008年1月1日至2018年6月30日。总结心包积气新生儿的临床特点及诊治方法。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果对本例心包积气新生儿的研究结果如下。①病史采集:本例新生儿为男性,出生胎龄为36周,无胎膜早破、宫内窘迫及羊水粪染病史,出生体重为2 750 g,生后1、5、10 min Apgar评分分别为9、10、10分。②入院相关检查结果:胸部X射线摄片检查结果提示湿肺合并感染可能,新生儿呼吸窘迫综合征(NRDS)待排查;动脉血气分析结果提示呼吸性酸中毒;心脏彩色多普勒超声检查及血常规、C反应蛋白、电解质检查结果,以及肝、肾功能,均未见明显异常。③治疗与转归:本例新生儿经呼吸机辅助机械通气治疗后,出现大量心包积气,合并气胸、纵隔气肿、间质性气肿、皮下气肿等其他气漏综合征症状,并且合并心包填塞、心排血量低症状。临床对该例新生儿并未立即进行常规心包穿刺术,而是采取胸腔穿刺术+高频振荡通气(HFOV)治疗,新生儿接受此方法治疗后,心包积气于24 h内被完全吸收。新生儿住院治疗30 d后,治愈出院。文献复习结果如下,共计检索14篇新生儿心包积气相关文献,涉及15例心包积气新生儿。其中,8例新生儿未合并心包填塞,除1例因为大量心包积气采取心包穿刺术治疗外,其余7例均采取吸氧处理,8例均治愈出院。另外7例合并心包填塞新生儿均进行心包穿刺术,其中6例进行穿刺术后持续引流,4例联合胸腔穿刺术,2例因放弃治疗后死亡,其余5例均治愈出院。这5例治愈出院新生儿中,2例心包穿刺术失败,失败后,其中1例采取HFOV+胸腔穿刺术及术后引流治疗,1例采取胸腔穿刺术及术后引流+间歇指令通气(IMV)治疗,均获得良好治疗效果。结论对于生命体征、心脏血液动力学稳定的心包积气新生儿,甚至合并心包填塞时,建议首先采取保守治疗策略。胸腔穿刺术+HFOV治疗,可能对改善新生儿心包积气有效,同时又可避免心包穿刺术可能导致的风险。