PNEUMOPERICARDIUM FOLLOWING SEVERE THORACIC TRAUMA

Objectives: Pneumopericardium (PPC) is a rare clinical condition characterized by the collection of air in the pericardial sac. Although variable in etiology, the majority of reported cases occurs secondary to direct traumatic chest injury resulting in air escaping the visceral pleura into a pericardial defect (Macklin effect). The purpose of this study is to review the injury characteristics for those diagnosed with PPC and the incidence of restrictive cardiomyopathy with severe thoracic injury.

Methods: 81,954 trauma patients were evaluated and treated at our ACS-verified Level 1 adult trauma center between January 2015 to December 2021. The trauma registry was queried to identify patients with PPC. The electronic medical record (EMR) was reviewed for demographics, physiology, injury patterns, surgical interventions, length of stay (LOS), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS)-chest score, complications, and death.

Results: 16 patients were identified with a mean age of 42 + 17.7 years (Range 14 - 77), predominantly male (81%) and from blunt trauma (69%). Median GCS score was 11, ISS = 31 + 14.4 and AIS-chest = 3. Majority of patients had a pneumothorax requiring a thoracostomy (88%) with 56% demonstrating rib fractures radiographically. All patients required ICU admission, a mean LOS 13.6 + 14 days and a total LOS of 23 + 27 days. Three patients required an emergent pericardial window for tension physiology on initial presentation while the remaining demonstrated resolution over time. Overall incidence of PPC was < 1% of all trauma admissions. Three deaths occurred in the cohort following comfort care decisions related to their underlying severe traumatic brain injury.

Conclusion: PPC is an uncommon phenomenon typically associated with severe thoracic trauma. Tension physiology requiring decompression is rare, and most patients with PPC can be managed with supportive care.