Will pneumopericardium (presence of air in the pericardial space) self-resolve?

From the Guidelines

Pneumopericardium can sometimes resolve on its own, but this depends on the underlying cause and severity, and immediate intervention is often required to prevent complications. The management of pneumopericardium should prioritize the patient's clinical stability, with unstable patients needing urgent decompression. Pneumopericardium occurs when air enters the pericardial space, commonly due to trauma, iatrogenic causes, or connection to air-filled structures. The body can gradually reabsorb small amounts of air from the pericardial space, allowing for self-resolution in mild cases, as noted in the guidelines for pericardial diseases 1. However, tension pneumopericardium, where air accumulates under pressure, is a medical emergency requiring prompt intervention to prevent cardiovascular collapse, and pericardiocentesis is a recommended treatment approach for cardiac tamponade 1. Some key points to consider in the management of pneumopericardium include:

• The size and location of the air collection
• The presence of symptoms such as chest pain or shortness of breath
• The patient's overall clinical stability
• The need for urgent intervention to prevent complications such as cardiac tamponade Regular follow-up imaging is essential to confirm resolution and detect any recurrence or complications, and the use of echocardiography or other imaging modalities can help guide management decisions 1. In general, the approach to managing pneumopericardium should be individualized based on the patient's specific clinical presentation and underlying cause of the condition.

From the Research

Pneumopericardium Resolution

• Pneumopericardium is often self-limiting, requiring no specific therapy 2, 3
• Most cases of pneumopericardium resolve spontaneously, but some may develop severe complications such as cardiac tamponade 4
• In patients where there is a concomitant pneumothorax, chest tube drainage suffices 2
• Hemodynamically stable patients with pneumopericardium can be monitored on medical treatment 5

Complications and Management

• Pneumopericardium can progress to tension pneumopericardium, which requires immediate recognition and management 6, 3
• Tension pneumopericardium requires immediate pericardial aspiration 6
• Operative fixation is required for injury to vital structures such as the tracheobronchial tree or esophageal tears 2

Diagnosis and Monitoring

• The diagnosis of pneumopericardium is easily made on plain chest radiography 2
• Chest computed tomography and transthoracic echocardiography can also be helpful in making the diagnosis 2, 3
• Patients with pneumopericardium should be monitored for signs of complications and hemodynamic instability 5