A H Mohd Mustamam S S N Syed Shamsuddin



Pneumopericardium is defined as collection of air or gas in the pericardial cavity. It is a rare complication of tuberculosis and HIV. Pneumopericardium most commonly results from trauma, approximately 60%, other causes can be due to iatrogenic and noniatrogenic. Development of spontaneous pneumopericardium is a very rare complication of tuberculosis with coexisting HIV infection.


22 year old male man with no known medical illness, and not obese. P presented to Emergency Department due to with on and off pleuritic chest pain for the past 2 weeks, associated with mild dyspnea. Pain is was relieved by rest and leaning forward. On examination patient was alert, pink and not tacypneic. Vital signs was were stable, the lungs were clear, equeal air entry, no hyperesonance, CVS no heart murmur and no pericardial rub heard, per and the abdomen was soft and non tender. Chest xray erect done showed lucencies around the right and left heart border suggestive of pneumopericardium, with no pneumothorax or mediastinal mass. The ECG, showed sinus rhythm with no acute ischaemic changes. Patient remained stable and was admitted to the ward for further investigation.


Spontaneous pneumopericardium is a very case rare. Cases that have been reported usually are related to tuberculosis and immunocompromised patients, which is not in this case. The pathogenesis of pneumopericardium is increase in intraalveolar pressure with alveolar overdistention that results in rupture of alveolar walls, allowing air to travel through the pulmonary interstitium along perivascular sheaths to the lung hilum and mediastinum and to the pericardial reflection. Pericardial connective tissue is discontinuous at the reflection of parietal onto visceral pericardium near the ostia of the pulmonary veins so that there is a site of potential weakness where a microscopic dissection of air into the pericardial sac is possible. It is potential that in this case it is related to vasalva maneuver with forced expiration against a closed glottis in exertional activity. 


Supplementary Issue