Pneumopericardium & Pneumomediastin

um
By:
Nilacindy Ardilah (30101507525)
dr. Dria Anggraeny Sutikno, Sp. Rad
Pneumopericardium
Air in the pericardial space
PERICARDIUM
Etiology

Underlying causes include:

• positive pressure ventilation
• thoracic surgery/pericardial fluid drainage
• penetrating trauma
• blunt trauma (rare)
• infectious pericarditis with gas-producing organisms
• fistula
• between the pericardium and an adjacent air-
containing organ (i.e. stomach or esophagus)
Finding
Clinical
• Depend on the amount of air
and how rapidly it accumulates
• Substernal chest pain
• Hypotension, bradycardia,
hypoxia
• Hamman’s sign: a continuous
crunching or clicking noise
synchronous with the heart
beat heard best in the left
lateral decubitus position
Imaging
• The heart is partially or
completed surrounded by a rim
or air- density
• The parietal pericardium may be
visible as a thin line
• Characteristically, air in the
pericardium (unlike air in the
mediastinum)  remains below
the level of the great vessels
 There is marked "ground-glass" opacification to both lungs
in this newborn with severe hyaline membrane disease on
assisted ventilation.
Surrounding the heart is a band of air-density (white arrows)
which does not extend above the level of the root of the
aorta or pulmonary arteries, characteristic of
pneumopericardium.
Incidentally, the tip of the endotracheal tube is down too far
as it extends into the right main bronchus.

Imaging This is the "scout" image from

a CT scan of the chest.
Notice the halo of air
surrounding the heart (white
arrows) that does not extended
above the
level of the great vessels (red
arrow). The patient was
stabbed in the chest.
Pneumomediastinum
Air in the mediastinum
MEDIASTINUM
Organ - organ di dalamnya:

1. Mediastinum superior: 2. Mediastinum inferior.

- Trakea . - Jantung.
- V. inominata. - Bronkus.
- Esofagus. - a. pulmonalis.
- V. cava superior. Batas mediatinum superior dan inferior:
- Duktus thoracicus. Pertengahan manubrium sterni
- Timus.
- Arcus aorta.
- N. vagus & phrenicus
Etiology
• blunt or penetrating chest trauma
• secondary to neck, thoracic, or retroperitoneal surgery
• esophageal perforation
• Boerhaave syndrome
• endoscopic intervention
• esophageal carcinoma
• tracheobronchial perforation
• laceration
• bronchial stump dehiscence
• bronchoscopy
• tracheostomy
• laryngeal fracture
Etiology
• vigorous exercise
• Childbirth
• weightlifting
• Valsalva maneuver
• asthma
• barotrauma 
• diving
• ventilator: most commonly secondary to ARDS with
positive pressure ventilation
Etiology
• infection
• tuberculosis
• histoplasmosis
• dental or retropharyngeal infection
• mediastinitis
• interstitial lung disease
• connective tissue disorders 
• polymyositis/dermatomyositis, uncertain if related to
vasculopathy or associated interstitial lung disease
• idiopathic

Although it is rare, pneumomediastinum can occur spontaneously.

This is considered benign and generally affects young adult males 
Imaging

Blue arrow points to "continuous diaphragm sign." The entire diaphragm

is visualized from one side to the other because air in the mediastinum
outlines the central portion which is usually obscured by the heart and
mediastinal soft tissue structures that are in contact with the diaphragm.
The red arrow points to the air beneath and posterior to the heart.
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