Pneumopericardium in a Preterm Infant with Marked Pulmonary Hypoplasia

The image shows the chest X-ray of a preterm infant (33 + 5 gestational weeks, birth weight 1.9 kg) 3 days after birthreduced amniotic fluid (anhydramnion). The infant was delivered in the setting of anhydramnios due to bilateral renal agenesis and marked pulmonary hyperplasia. Due to the resulting severe pulmonary hypertension and impaired oxygenation, intensive high-frequency oscillatory ventilation was initially required (mean airway pressure 14.5 mbar, amplitude 50 mbar, frequency: 9 Hz). In the first 2 days of life, bilateral pneumothoraces developed, which were drained using pigtail catheters. On the third postnatal day, the image presented here revealed severe tension pneumopericardium (arrows), which led to reduced cardiac output. Decompensation by means of pericardiocentesis stabilized the patient and resulted in complete resolution of the pneumopericardium. The patient is currently 2 months old, has stable spontaneous breathing from a cardiorespiratory perspective, but remains dependent on peritoneal dialysis. Pneumopericardium is a rare form of air-leak syndrome that causes potentially life-threatening low cardiac output (pericardial tamponade) as a result of venous inflow congestion. The most frequent triggers, in addition to barotrauma at high ventilation pressures, include chest trauma and chest compression.

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PD Dr. med. Christian Tomuschat, Klinik und Poliklinik für Kinderchirurgie, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), [e-mail]

Dr. med. Julian Jürgens, Zentrum für Radiologie und Endoskopie, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Abteilung für Kinderradiologie, Universitätsklinikum Hamburg-Eppendorf (UKE)

PD Dr. med. Philipp Deindl, Sektion Neonatologie und Pädiatrische Intensivmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE)

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Tomuschat C, Jürgens J, Deindl P: Pneumopericardium in a preterm infant with marked pulmonary hypoplasia. Dtsch Arztebl Int 2022; 119:276. DOI: 10.3238/arztebl.m2022.0020