Differential Diagnosis for Tiny Pneumopericardium with Air in the Right Ventricle and Scattered Air in the Upper Chest

• Single Most Likely Diagnosis
  • Pneumothorax with barotrauma: This condition could lead to air leaking into the pericardial space and the right ventricle, especially if there's a rupture of the lung or airways. The scattered air in the upper chest supports this diagnosis, as it could indicate air escaping from the lungs or airways.
• Other Likely Diagnoses
  • Esophageal rupture: This could lead to air leaking into the mediastinum and potentially into the pericardial space and right ventricle. The presence of scattered air in the upper chest could be consistent with this diagnosis.
  • Traumatic injury: A traumatic event could cause a rupture of the trachea, bronchi, or lungs, leading to air leakage into the pericardial space and right ventricle.
• Do Not Miss Diagnoses
  • Boerhaave syndrome (spontaneous esophageal rupture): Although less common, this condition is life-threatening and requires immediate attention. The presence of air in the pericardial space and right ventricle, along with scattered air in the upper chest, could be indicative of this condition.
  • Cardiac rupture: A rupture of the heart, potentially due to trauma or myocardial infarction, could lead to air entering the pericardial space and right ventricle.
• Rare Diagnoses
  • Pneumopericardium due to gas-producing infection: Although rare, a gas-producing infection in the pericardial space could lead to the accumulation of air. However, this would typically be accompanied by other signs of infection, such as fever and leukocytosis.
  • Iatrogenic pneumopericardium: This could occur as a complication of a medical procedure, such as a central line placement or cardiac catheterization. However, this would typically be recognized immediately after the procedure.