• C P Bleeker-Rovers, F J J van den Elshout, T I F M Bloemen, and H A H Kaasjager.
• Department of Internal Medicine 541, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands. C.Bleeker-Rovers@nucmed.umcn.nl
• Neth J Med. 2003 Feb 1;61(2):54-6.

AbstractA 22-year-old man was admitted with pneumonia. He was immediately intubated and positive pressure ventilation was initiated. Blood and sputum cultures showed Bacteroides fragilis and Corynebacterium sp., which were treated with metronidazole and clindamycin. Three weeks later his blood pressure suddenly dropped with an elevation of the central venous pressure. Chest X-ray revealed a pneumopericardium. A parasternal mediastinotomy with partial pericardiectomy was immediately performed. On opening the pericardium his blood pressure normalised. The patient gradually recovered and six weeks after admission he was extubated. Two weeks later he was discharged. A pneumopericardium without previous thorax trauma is very rare and early recognition is imperative because a tension pneumopericardium with cardiac tamponade may develop, as happened in this case. A tension pneumopericardium has to be treated with immediate pericardiocentesis followed by partial pericardiectomy to avoid recurrence.

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