Vol 30, No 2 (2023)
Image in Cardiovascular Medicine
Published online: 2023-04-17

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Hydropneumopericardium after pericardiocentesis in a transplant patient

Arnaud Planchat1, Florian Stierlin1, Alix Juillet de Saint-Lager-Lucas2, Andrea Peloso3, Sarah Mauler-Wittwer1, Stephane Noble1
Pubmed: 37083173
Cardiol J 2023;30(2):335-336.

Abstract

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clinicAL CARDIOLOGY

IMAGE IN CARDIOVASCULAR MEDICINE

Cardiology Journal

2023, Vol. 30, No. 2, 335–336

DOI: 10.5603/CJ.2023.0024

Copyright © 2023 Via Medica

ISSN 1897–5593

eISSN 1898–018X

Hydropneumopericardium after pericardiocentesis in a transplant patient

Arnaud Planchat1Florian Stierlin1Alix Juillet de Saint-Lager-Lucas2Andrea Peloso3Sarah Mauler-Wittwer1Stephane Noble1
1Department of Medicine, Cardiology Division, Structural Heart Unit, University Hospitals of Geneva, Switzerland
2Department of Diagnosis, Radiology, University Hospitals of Geneva, Switzerland
3Department of Surgery, Transplantation Division, University Hospitals of Geneva, Switzerland

Address for correspondence: Dr. Arnaud Planchat, Cardiology Division, Department of Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland, tel: +41796909458, e-mail: arnaud.planchat@hcuge.ch

Received: 12.07.2022 Accepted: 5.03.2023

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 52-year-old man, known for intestinal transplantation of a mesentery desmoid tumor, chronic pericardial effusion repeatedly drained, presented with upper gastro-intestinal bleeding on severe gastric polyposis and bacterial translocation. Transthoracic echocardiography showed severe circumferential effusion measuring up to 2.6 cm (1.6 cm toward the needle), with echocardiographic signs of tamponade, indicating pericardiocentesis.

Through subxiphoid puncture, 860cc of citrine liquid was retrieved. The drain was left in place. Control chest X-ray showed hydropneumopericardium (Fig. 1A, B). On computed tomography (CT)-scanner, the drain crossed the left hepatic lobe, followed the heart’s inferior wall with its distal end in the pericardial cavity (Fig. 1C). Fistula with air-containing cavities was excluded. Daily aspiration removed 420cc of citrine fluid with air. The drain was removed at day 4. Radiographic follow-up showed diminution of air and liquid (Fig. 1D, E). Cytologic examination found reactionary mesothelial cells and microcalcifications.

Figure 1. Chest X-ray after pericardiocentesis: front (A) and profile (B). Three-dimensional non injected computed tomography-scan reconstruction from a lateral angle showing drain pathway (C); D. Chest X-ray before drain removal on day 3; E. Chest X-ray after drain removal.

Hydropneumopericardium is caused by trauma, infection secondary to gas-producing bacilli, fistula with adjacent air-containing organs, baro-traumas (positive pressure ventilation, mostly in neonates). It can develop after procedures (e.g., pericardiocentesis, endotracheal intubation, thoracotomy, pneumectomy) or spontaneously. Herein, fistula was excluded on CT-scan. No air was insufflated during insertion or through drain misuse. In the absence of other etiology, the most likely cause is iatrogenic, considering the unusual path of the drain. Chronic pericardial effusion and its inflammatory nature could have favored a reshaped hardened fibrous pericardium, prompt to fistulize or unable to adhere to its serous part.

Complications of hydropneumopericardium include pericarditis, tension and tamponade. Easily diagnosable, it should be suspected when dyspnea follows a brief relief after pericardiocentesis.

Conflict of interest: None declared