Chest
Volume 112, Issue 5, November 1997, Pages 1441-1443
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Selected Reports
Pneumopericardium Associated With Face-Mask Continuous Positive Airway Pressure

https://doi.org/10.1378/chest.112.5.1441Get rights and content

This is an uncommon case of a patient who developed pneumopericardium while being treated with face-mask continuous positive airway pressure (CPAP) for hypoxic respiratory failure following a coronary artery bypass graft surgery. A pneumopericardium detected by chest radiograph resolved completely after discontinuation of face-mask CPAP. Possible mechanisms that may have been involved in this unusual complication are reviewed.

Section snippets

CASE REPORT

A 65-year-old male veteran underwent a five-vessel CABG at the University Medical Center in Jackson, Miss. His postoperative course was complicated by prolonged mechanical ventilation. On the 7th postoperative day, he was extubated and placed on conventional face mask with 40%; FIo2 and intermittent CPAP of 5 cm H2O. On the 9th postoperative day, he was transferred back to the coronary care unit at the VA Medical Center in Jackson, Miss, for further postoperative management and observation.

DISCUSSION

Pneumopericardium, a form of barotrauma, refers to the presence of air within the pericardial sac, a condition that is much less common than either pneumothorax or pneumomediastinum. Pneumopericardium results from mediastinal air dissecting at the reflection of the parietal to visceral pericardium near the ostia of the pulmonary veins.6 This occurs more frequently in infants than in adults. This is probably due to the stronger adhesions between the pericardial layers in the adult, precluding

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