The heart is encased within a double-layered protective sac called the pericardium. Pneumopericardium occurs when air accumulates within this sac resulting in increased pressure around the heart. So how does air get there?

Blunt or penetrating trauma to the chest can cause mediastinal disruption potentially leading to pneumopericardium. In addition, it’s fairly common to see some air trapped within the remaining pericardium after cardiac surgery or after lung damage (trauma, mechanical ventilation, etc.) with subsequent pneumomediastinum.

The diagnosis is usually incidental on an X-ray or CT scan with treatment ranging from conservative management with observation to more invasive procedures to remove the air from within the pericardium directly.

In this video, fluoroscopy reveals pneumopericardium during a left heart catheterization supported by an Impella CP.

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