|Year : 2023 | Volume
| Issue : 1 | Page : 1-6
Trauma-related pneumopericardium: A literature review
Ayman O Nasr1, Humood Alsadery2, Adel Osman1, Abdulrahman Alblowi2, Omar Bamalan2, Ahmed Alshaikhi2, Nader Alosaimi2, Yasser ElGhoneimy3, Mamoun A Nabri1
1 Department of Surgery, Trauma Unit, King Fahad Hospital of the University, Khobar; Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
2 Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
3 Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam; Department of Surgery, Cardiac Surgery Unit, King Fahad Hospital of the University, Khobar, Saudi Arabia
|Date of Submission||05-Dec-2022|
|Date of Decision||08-Jan-2023|
|Date of Acceptance||11-Jan-2023|
|Date of Web Publication||15-Mar-2023|
Ayman O Nasr
Department of Surgery, Trauma Unit, King Fahad Hospital of the University, Khobar 31952
Source of Support: None, Conflict of Interest: None
Trauma-related pneumopericardium (TRPP) is the collection of air in the pericardial space secondary to trauma, potentially leading to tension pneumopericardium (TPP) in which the entrapment of air generates sufficient pressure to compromise cardiac output leading to a life-threatening cardiac tamponade and circulatory failure. We aim to classify the diagnostic and therapeutic approaches of TRPP and the causes of the subsequent development of TPP. A computer-based search of all published reports on TRPP in the medical literature from database inception to March 2020, on MEDLINE, Ovid, and Scopus; analyzing the data regarding initial status at presentation, extent of injuries, diagnostic and treatment measures with the intention to have an understanding of the clinical behavior and management outcomes of TRPP. The search identified 84 published case reports of 105 patients with TRPP. In conclusion, TRPP leading to TPP is described in the literature as a condition that involves a young male who is subjected to blunt trauma, most commonly in a motor vehicle collision, presenting as a polytrauma patient in a state of shock and low systolic blood pressure, or possibly in cardiac arrest. In addition, he might have a tracheobronchial injury with or without pneumothorax or pneumomediastinum and might require mechanical ventilation.
Keywords: Pneumopericardium, simple, tamponade, tension and simple pneumopericardium, trauma, traumatic
|How to cite this article:|
Nasr AO, Alsadery H, Osman A, Alblowi A, Bamalan O, Alshaikhi A, Alosaimi N, ElGhoneimy Y, Nabri MA. Trauma-related pneumopericardium: A literature review. Saudi J Health Sci 2023;12:1-6
|How to cite this URL:|
Nasr AO, Alsadery H, Osman A, Alblowi A, Bamalan O, Alshaikhi A, Alosaimi N, ElGhoneimy Y, Nabri MA. Trauma-related pneumopericardium: A literature review. Saudi J Health Sci [serial online] 2023 [cited 2023 Jun 10];12:1-6. Available from: https://www.saudijhealthsci.org/text.asp?2023/12/1/1/371710
| Introduction|| |
Pneumopericardium was first described in 1844 by Bricheteau and labeled as a clinical entity in 1855 by Stokes. Simple pneumopericardium or nontension pneumopericardium (NTPP) is the collection of air in the pericardial space most commonly due to trauma. Trauma-related pneumopericardium (TRPP) was described in 1931 by Shackleford and delayed formation of TRPP was reported in 1966, causes of NTPP include mechanical ventilation, iatrogenic perforation, pericardial space infection, and perforation of a hollow viscus in the pericardial space were also reported. Tension pneumopericardium (TPP) is a severe form of pneumopericardium that occurs due to the entrapment of gas in the pericardial space generating sufficient pressure to compromise cardiac output leading to a life-threatening cardiac tamponade and circulatory failure. TPP is documented to take place 24 h after trauma resulting in a delayed or missed intervention with a fatal outcome in some reports., The diagnosis and appropriate management of TPP remain a clinical challenge for trauma care front liners. The aim of this review is to assess and compare the different diagnostic and therapeutic approaches of TRPP and subsequent development of TPP.
| Methodology|| |
This review was carried out following the PRISMA guidelines. The primary aim of the review is to assess and compare the diagnostic and therapeutic approaches of TRPP. Additional include the study of possible parameters related to the subsequent development of TPP. The main outcome of the data analysis was to compare the end result of TRPP in terms of mortality between TPP and NTPP and its relation to clinical behavior and management provided.
An internet-based search of MEDLINE, Ovid, Web of Science, Science Direct, Scopus, Cochrane Database of Systematic Reviews, and Google Scholar databases was conducted on all published cases of TRPP in the literature, with or without tension, published from database inception to March 2020. Non-English literature was screened as well and translated into English when required. The search used pneumopericardium, trauma, traumatic, simple, tamponade, tension, and simple pneumopericardium, as isolated or combined search words.
Screening of the reports
A cross-check of all references documented in the retrieved reports was also performed to avoid any missing reports. Two authors in this review, after conducting the computer search, have exchanged the collected reports with another two authors for cross-review and validation of the inclusion criteria as well as all exclusion criteria of TRPP with or without the tamponade effect. Any TRPP case that was reported as a postmortem or in the form of a clinical study was excluded due to the lack of patients' details diagnostic data to identify TRPP with or without tension premortem. Murad tool for appraisal and application of evidence derived from case reports and case series was used in this review. After removing the duplicates, data on authors, report type, year of reported, number of cases reported, age, gender, initial status at presentation, extent of injuries, diagnostic and treatment tools used, factors related to the development of TPP, and management outcomes of TRPP were collected.
Data extraction and analysis
A descriptive analysis of the collected data was performed. Some continuous data are presented as categorical whenever cutoff levels are required to differentiate between two or more contrast groups of one data set as using systolic blood pressure (SBP) reading of 110 mmHg to be the cutoff point to categorize hypotensive and normotensive status of reported patients and heart rate of 100 bpm again to categorize stable and unstable reported patients. Categorical data such as gender, trauma type and cause, treatment type, and outcome were plotted in the form of ratios and percentages.
| Results|| |
The search identified 87 published case reports of 108 patients with TRPP.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, After the exclusion of four reports mostly due to missing full text [Table 1], the total of 83 publications reporting 105 patients were included in this review [Figure 1].
|Figure 1: Flow diagram of the literature search and reports screening of reports. TRPP: Trauma-related pneumopericardium, TPP: Tension pneumopericardium, NTPP: Nontension pneumopericardium|
Click here to view
Statistically, the patient's chance of cure is 45% with decompression alone, 23% after an operative intervention, and 7% after multiple treatment modalities, with an unfortunate mortality rate of 26% most probably not due to TPP.
Etiology and clinical presentation
TRPP predominantly affected young males with a male: female of 8.5:1 (90% males) and an age range of 3–75 years (mean 24.5). TPP occurred in 69 patients (65.7%), most of them are associated with polytrauma, 53 patients (77%) and only 16 patients developed TPP as a result of isolated chest trauma (25%). Blunt trauma was by far the most common cause of trauma-associated pneumopericardium accounting for (84%) in our review and in literature. Motor vehicle collision (MVC) represents the most common cause of TRPP (59%) followed by stab wounds (12%) and fall from height (13%). A preliminary calculation of the listed injuries for each patient shows that 81% of patients have a possible severe injury based on an expected injury severity score (ISS) >15 with only 5.7% missing data.
Half of the patients (53%) were reported to be stable at presentation (based on the documented vitals in the report at presentation, when available 49%–62% missing data, or on the report of the authors on the hemodynamic status of the patient at presentation), 17% were unstable and 13% developed cardiac arrest during their management [Table 2].
|Table 2: Percentage of clinical findings at presentation for tension pneumopericardium and nontension pneumopericardium|
Click here to view
Dyspnea was the most common presenting symptom (35%) followed by chest pain (25%) and the combination of both symptoms, dyspnea and chest pain, occurred in 16% of patients. TRPP is recognized at the time of presentation in 75% of patients, two-third of them (67%) subsequently develop TPP. Seriously enough, TRPP developed in up to 24% of patients without initial evidence at presentation, one-fifth of them (20%) developed TPP, this is higher than a previously reported incidence of 9.5%. Pneumothorax was the most frequent injury associated with TRPP (71%) followed by pneumomediastinum (42%), central and subcutaneous emphysema (40%), fracture ribs (30%), tracheobronchial injury (9%), and sternal fracture (5%) [Table 3].
|Table 3: Percentage of associated injuries at presentation for tension pneumopericardium and nontension pneumopericardium|
Click here to view
Diagnosis and management
The diagnosis of TRPP was predominantly established using a chest X-ray in 91% of patients. Computed tomography scan was introduced as a diagnostic tool in reports since 1994 onward. It was the test of choice in 52% of the patients with or without chest X-ray, especially in polytrauma patients. Bronchoscopy was required in 28% of patients to rule out tracheobronchial injuries.
Mechanical ventilation was required in 56% of patients, while only 35% of patients required pericardial decompression, and 23% required intercostal tube (ICT) drainage of the pleural space. The operative decompression was required in 17% of patients; conservative noninterventional approach was accomplished in 16% of patients. Combined therapy in the form of decompression plus ICT insertion or open pericardial approach was performed on 4 and 3% of patients, respectively. The vast majority of reported patients (81%) had complete resolution of their pneumopericardium, 18% died from different causes but not directly due to pneumopericardium and only 1% died as a direct sequel of TRPP [Table 4].
|Table 4: Percentage of provided treatment approach and outcome for tension pneumopericardium and nontension pneumopericardium|
Click here to view
| Discussion|| |
The highest number of pneumopericardium in literature of all types was reported by Cummings et al. in 1984 reviewing 252 cases. Their 100-year incidence of TRPP was 62% of all pneumopericardium cases. Blunt trauma represents 85% of all TRPP consistent with our review of 84%. The incidence of penetrating trauma from three reviews (Cummings et al., Demetriades et al., and Nicol et al.) ranged between 8% and 15% which is again comparable to an incidence of 16% in our review. Trauma-related TPP is documented in 3 patients in Cummings et al.'s review, 1 in Nicol et al.'s review and 1 in Demetriades et al. review. Other causes such as mechanical ventilation, iatrogenic perforation, pericardial space infection, and perforation of a hollow viscus in the pericardial space are also reported.
Blunt trauma is proven to be by far the most common cause of trauma-associated pneumopericardium accounting for 84% in our review and in literature. MVC was reported as the most common blunt trauma modality, followed by falls from a great height which came in support of our findings for motor vehicle collision (MVC) being the most common cause accounting for 59% followed by fall from height with 13% incidence. The presence of myocardial, pericardial, or aortic trauma was taken as an indicator of a possible pneumopericardium in support of our findings.
Three possible passageways are described in literature regarding the pathophysiology of pneumopericardium and accumulation of air in the pericardial space in the absence of a direct communication/trauma. First is the escape of air from alveoli into the interstitial space along the pulmonary perivascular sheaths (the Macklin effect). Second is through a congenital pleuropericardial connection that can become active in the presence of a pneumothorax. Third is through disruption of the alveolar or pleuropericardial membrane that can lead to the development of a “one-way valve” allowing continued inflation of the pericardial sac without notable deflation. Technically, any of the three passages can occur as a result of blunt thoracic trauma, which in the presence of increased pleural pressure, as in positive pressure ventilation,, can push air into the pericardial space with a resultant pneumopericardium. On the other hand, penetrating chest trauma can cause a passageway through direct disruption of the pericardial sac, or indirectly through a disruption of the tracheobronchial, gastrointestinal, pleural, or mediastinal spaces.
Regardless of the mechanism and the site of disruption, air in the pericardial space can cause TPP and if there is a passageway to the pericardial sac, gas will continue to flow under enough pressure, resulting in a tamponade effect. The tamponade effect occurs when the venous pressure increases proportionately with further increase in the pericardial gas under pressure. Tamponade was developed under experimental environments when the intrapericardial pressure has exceeded 266 mm H2O. Adcock et al. the experiment revealed that to maintain adequate hemodynamics, venous pressure should exceed pericardial pressure by 35 mm H2O, Hymes et al. suggests less pressure difference exceeding 14.5 cm H2O for tamponade to develop. Maurer et al. in 1958 as a result of similar experiments stated that the rate of air insufflation is a major factor in the production of cardiac tamponade. The risk of TPP was high in conditions such as blunt trauma, severe trauma with ISS >15, pneumothorax, pneumomediastinum, tracheobronchial injury, and the use of mechanical ventilation.
The conservative approach was more commonly associated with NTPP, resulting in a complete resolution in 42% of patients. Nonetheless, decompression commonly through a subxiphoid window was the most common approach for TPP accounting for 45% and 52% when combined with another modality such as ICT insertion or proceeding to open surgery. The direct operative treatment was required in 23% of TPP patients. The overall mortality was more commonly associated with TPP mainly related to the severity of trauma and the development of complications (e.g., sepsis or septic shock).
The most important limitations of the study are; the search only covered English literature which makes a missed non-English report of TRPP a possible limitation, moreover, the time variation in recording the initial vital signs based on which some conclusions regarding patients' initial haemodynamic status and stability were drawn could also represent a possible limitation in the drawn findings included in this review.
| Conclusion|| |
TRPP leading to TPP is described in literature as a condition that involves a young male with a mean age of 24 years who is subjected to a blunt trauma, most commonly MVC. He presents as a polytrauma patient with an ISS >15 in a state of shock and low SBP, could also present with cardiac arrest. He is likely to have a tracheobronchial injury with or without a pneumothorax or pneumomediastinum and very likely requires mechanical ventilation. He has a 45% chance of cure with decompression alone and a 23% chance of operative intervention to be cured and a 7% of having multiple treatment modalities to be cured. Unfortunately, he has a 26% chance to die mostly not due to TPP.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shackelford RT. Hydropneumopericardium: report of a case with a summary of the literature. JAMA 1931;96:187-91.
Hancock EW. Low voltage in a trauma victim. Hospital practice (Office ed) 1987;22:57, 60.
Hirani S, Velez Martinez CS, Patan S, Kavanaugh M. Cancer-Related Pneumopericardium: A Case Report and Literature Review. Case Rep Oncol 2020;13:23-8. doi: 10.1159/000504935.
Heimer J, Bolliger SA, Thali MJ, Schweitzer W. Tension pneumopericardium following suicidal stab wounds to the chest. Forensic Sci Med Pathol 2017;13:464-7. doi: 10.1007/s12024-017-9927-9.
Baharudin A, Sayuti RM, Shahid H. The Macklin effect-pneumomediastinum and pneumopericardium following blunt chest trauma. Med J Malaysia 2006;61:371-3.
Sutherland T, Parsons S, Cordner S, O'Donnell C. Tension pneumopericardium following blunt chest trauma. J Med Imaging Radiat Oncol 2019;63:358-9.
Osinowo O, Adebo O. Pneumopericardium following blunt chest injury: Report of three cases. Injury 1986;17:110-2.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al.
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018;23:60-3.
Cargill AO, Galasko CS, Gunning AJ. Pneumopericardium following closed chest injury: A report of two cases. Injury 1973;4:221-4.
Borrie J, Lichter I. Pericardial rupture from blunt chest trauma. Thorax 1974;29:329-37.
Westaby S. Penumopericardium and tension pneumopericardium after closed-chest injury. Thorax 1977;32:91-7.
McCaughey W, King R. Pneumopericardium associated with tracheal rupture. Management of a case complicated by the shock lung syndrome. Anaesthesia 1975;30:199-205.
Andrew TA, Milne DD. Pneumoperitoneum associated with pneumothorax or pneumopericardium: A surgical dilemma in the injured patient. Injury 1979;11:65-70.
Hacker PK, Dorsey DJ. Pneumopericardium and pneumomediastinum following closed chest injury. JACEP 1979;8:409-11.
Milachowski K, Jaeschock R, Moschinski D, Müller G. Pneumoperikard nach thoraxbagatelltrauma. Unfallchirurgie 1979;5:212-5.
Frascone RJ, Cicero JJ, Sturm JT. Pneumopericardium occurring during a high-speed motorcycle ride. J Trauma 1983;23:163-4.
McDougal CB, Mulder GA, Hoffman JR. Tension pneumopericardium following blunt chest trauma. Ann Emerg Med 1985;14:167-70.
Robinson MD, Markovchick VJ. Traumatic tension pneumopericardium: A case report and literature review. J Emerg Med 1985;2:409-13.
Mirvis SE, Indeck M, Schorr RM, Diaconis JN. Posttraumatic tension pneumopericardium: The “small heart” sign. Radiology 1986;158:663-9.
Pasztor B. Tension pneumopericardium. Aeromed J 1986;1:12.
Gupta KK. Cardiac air tamponade following closed chest injury. J R Coll Surg Edinb 1986;31:120-1.
Shorr RM, Mirvis SE, Indeck MC. Tension pneumopericardium in blunt chest trauma. J Trauma Acute Care Surg 1987;27:1078-82.
Spotnitz AJ, Kaufman JL. Tension pneumopericardium following penetrating chest injury. J Trauma 1987;27:806-8.
Knottenbelt JD, Divaris S. Tension pneumopericardium following stab wounds to the chest: Report of two cases. Injury 1989;20:46-8.
Wakaki N, Yamaguchi K, Inoue S, Matsumoto Y, Kin A, Huruta Y, et al.
Successful surgical treatment of a patient with tension pneumopericardium and left hemothorax caused by multiple rib fractures. Kyobu Geka 1989;42:577-81.
Demetriades D, Levy R, Hatzitheofilou C, Chun R. Tension pneumopericardium following penetrating trauma: Case report. J Trauma 1990;30:238-9.
Hudgens S, McGraw J, Craun M. Two cases of tension pneumopericardium following blunt chest injury. J Trauma Acute Care Surg 1991;31:1408-10.
Baksaas ST, Fosse E, Pillgram-Larsen J. Traumatic pneumopericardium with cardiac tamponade. Tidsskr Nor Laegeforen 1992;112:2085-7.
Hymes WA, Itani KM, Wall MJ Jr., Granchi TS, Mattox KL. Delayed tension pneumopericardium after thoracotomy for penetrating chest trauma. Ann Thorac Surg 1994;57:1658-60.
Nakamura T, Tabuse H, Murao Y, Konobu T, Nishimura A, Miyamoto S. 2 cases of the tension pneumopericardium following blunt chest trauma resulting in the cardiac tamponade. Nihon Kyobu Geka Gakkai Zasshi 1994;42:1242-6.
Capizzi PJ, Martin M, Bannon MP. Tension pneumopericardium following blunt injury. J Trauma Acute Care Surg 1995;39:775-80.
Levin S, Maldonado I, Rehm C, Ross S, Weiss RL. Cardiac tamponade without pericardial effusion after blunt chest trauma. Am Heart J 1996;131:198-200.
Hernández-Luyando L, González de las Heras E, Calvo J, López C, de la Puente H. Posttraumatic tension pneumopericardium. Am J Emerg Med 1997;15:686-7.
Gorecki PJ, Andrei VE, Schein M. Tension pneumopericardium in chest trauma. J Trauma 1999;46:954-6.
Rashid MA, Wikström T, Ortenwall P. Pneumopericardium and pneumoperitoneum after penetrating chest injury. Eur J Surg 1999;165:278-9.
Tubaliman Ş, Altıok T, Alper A, Kurul İC, Taştepe Aİ. Tension pneumopericardium after blunt chest trauma. Ulus Travma Acil Cerrahi Derg 1999;5:281-3.
Bronkhorst MW, Bruijninckx MM, Ulrich C. Tension pneumopericardium following blunt thoracic trauma and lobectomy. Injury 2000;31:124-5.
Howells GA, Uzieblo MR, Bair H, Boyer MD. Tension pneumopericardium during laparoscopy for trauma. Surg Laparosc Endosc Percutan Tech 2000;10:44-6.
Gould JC, Schurr MA. Tension pneumopericardium after blunt chest trauma. Ann Thorac Surg 2001;72:1728-30.
Roth TC, Schmid RA. Pneumopericardium after blunt chest trauma: A sign of severe injury? J Thorac Cardiovasc Surg 2002;124:630-1.
Faroudy M, Marzouk N, Ababou A, Lazreq C, Sbihi A. Tension pneumopericardium: A rare complication after thoracic stab wound. Ann Fr Anesth Reanim 2002;21:731-3.
Franklin WJ, Arora G, Ayres NA. Pneumopericardium and pneumomediastinum in an adolescent after blunt chest trauma. Tex Heart Inst J 2003;30:338-9.
Hashmi S, Rogers SO. Tension pneumothorax with pneumopericardium. J Trauma 2003;54:1254.
Tansel OD, Ozdemir H, Yamak B. Tension pneumopericardium in chest trauma with gunshot wound. Ulus Travma Acil Cerrahi Derg 2003;9:304-6.
Kallel N, Beloeil H, Geffroy A, Albaladejo P, Marty J. Post-traumatic tension pneumothorax and pneumopericardium in spontaneous ventilation. In: Annales Francaises D'anesthesie et de Reanimation. 2004;23:364-6.
Ladurner R, Qvick LM, Hohenbleicher F, Hallfeldt KK, Mutschler W, Mussack T. Pneumopericardium in blunt chest trauma after high-speed motor vehicle accidents. Am J Emerg Med 2005;23:83-6.
Yadav S, Sadasivan D, Sharma S. Tension pneumopericardium relieved by pigtail catheter. Eur J Cardiothorac Surg 2005;27:344.
Manson J, Nicol A, Navsaria PH. Tension pneumopericardium: A rare complication in penetrating chest trauma: A case report and review of the literature. Inj Extra 2005;36:349-51.
Haan JM, Scalea TM. Tension pneumopericardium: A case report and a review of the literature. Am Surg 2006;72:330-1.
Lonský V, Mand'ák J, Harrer J, Tuna M, Dvorák P, Dedek T, et al.
Posttraumatic pneumopericardium: A sign of severe injury or radiodiagnostic rarity? Acta Medica (Hradec Kralove) 2006;49:129-32.
Stegmaier J, Kirchhoff C, Biberthaler P, Buhmann S, Körner M, Ladurner R, et al.
Tension pneumopericardium – A rare complication in multiply injured patients. Unfallchirurg 2006;109:245-50.
Hagiwara S, Ogino T, Isaka A, Ihara N, Nakamura M, Nameki T, et al.
Tension pneumopericardium following a traffic accident. Inj Extra 2007;38:436-8.
Petteruti F, Stassano P, De Luca G, Di Tommaso L, Luciano A, Pepino P. Tension pneumopericardium and pneumothorax during spontaneous ventilation. J Thorac Cardiovasc Surg 2007;133:829-30.
Konijn AJ, Egbers PH, Kuiper MA. Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: A case report. J Med Case Rep 2008;2:100.
Markarian MK, MacIntyre DA, Cousins BJ, Fildes JJ, Malone A. Adolescent pneumopericardium and pneumomediastinum after motor vehicle crash and ejection. Am J Emerg Med 2008;26:515.e1-2.
Orak M, Üstündağ M, Onat S, Doğan H, Avcı A. 74 year-old-man with pneumopericardium due to blunt chest trauma: Case report. Dicle Tıp Dergisi 2008;4:277-9.
Visser F, Heine M, Levin AI, Coetzee AR. Pneumopericardium: Two case reports and a review. South Afr J Anaesth Analg 2008;14:41-5.
Levin AI, Visser F, Mattheyse F, Coetzee A. Tension pneumopericardium during positive-pressure ventilation leading to cardiac arrest. J Cardiothorac Vasc Anesth 2008;22:879-82.
Zakynthinos E, Karetsi E, Diakaki C. Pneumopericardium after blunt chest trauma: Mechanical ventilation with positive pressure must be avoided. Int J Cardiol 2008;124:e8-10.
Lee SY, Lee SJ, Jeon CW. Pneumopericardium occurring after stab wound to the chest. Am J Surg 2008;196:e10-1.
Polhill JL, Sing RF. Traumatic tension pneumopericardium. J Trauma Acute Care Surg 2009;66:1261.
Di Filippo A, Batacchi S, Ciapetti M, Spina R, Peris A. Pneumopericardium after major trauma. J Trauma Acute Care Surg 2009;66:1260.
O'Connor JV, Scalea TM. Tension pneumopericardium after blunt thoracic trauma. Ann Thorac Surg 2010;90:1713.
Sun GR, Goosen J, Florizoone M. Cardiac tamponade secondary to tension pneumopericardium from penetrating chest trauma. S Afr Med J 2010;100:150.
Sekhar A, Raheja P, Ikram S. The Macklin effect causing a pneumopericardium. J Cardiovasc Med (Hagerstown) 2012;13:527-8.
Vanzo V, Bugin S, Snijders D, Bottecchia L, Storer V, Barbato A. Pneumomediastinum and pneumopericardium in an 11-year-old rugby player: A case report. J Athl Train 2013;48:277-81.
Hippargi SH, Tonne V. Pitfalls in diagnosing a tension pneumopericardium – A case report. Int J Clin Med 2013;4:205.
Yılmaz S, Koç A. Traumatic right pericardial laceration with tension pneumopericardium associated with hemodynamic instability: A case report. ARYA Atheroscler 2013;9:210-2.
Chan WM, Love JD. Tracheal injury leading to tension pneumopericardium in a blunt trauma victim. Trauma 2015;17:137-9.
Flentje M, Krüger M, Ruschulte H. Pneumopericardium due to thorax compression: Overlooked resuscitation injury. Anaesthesist 2015;64:943-7.
Bartolek Hamp D, Ljubičić Q, Prkačin I, Cavrić G. Asymptomatic pneumopericardium after blunt chest trauma. Signa Vitae 2015;10 Suppl 1:77-8.
Van Peteghem S, Gevaert S. Tension pneumopericardium after blunt chest trauma. Acta Cardiol 2015;70:83.
Lin WT, Hung CC, Tu CL, Chao CM. Blunt chest trauma associated with tension pneumopericardium. J Emerg Med 2016;50:672-3.
Rolim Marques AF, Lopes LH, Martins Mdos S, Carmona CV, Fraga GP, Hirano ES. Tension pneumopericardium in blunt thoracic trauma. Int J Surg Case Rep 2016;24:188-90.
Nachi S, Okada H, Kato H, Suzuki K, Nakano S, Yoshida T, et al.
Simple pneumopericardium due to blunt trauma progressing to tension pneumopericardium during transportation. Am J Emerg Med 2016;34:933.e3-5.
Mishra B, Joshi MK, Rattan A, Kumar S, Gupta A, Sagar S. Pneumopericardium. Bull Emerg Trauma 2016;4:250-1.
Krawczyk L, Byrczek TP, Łuczyk A, Jagoda BD, Kazanowski R, Stasiowski MJ. Traumatic tension pneumopericardium and amputation of the left main bronchus. Kardiochir Torakochirurgia Pol 2017;14:63-5.
Naidu K, Jeans P. Traumatic pneumopericardium-case report and review of literature. J Trauma Care 2017;3:1013.
Rupprecht H, Gaab K. Tension pneumopericardium in a multiply injured child. Asian Cardiovasc Thorac Ann 2017;25:550-2.
Vivekananthan P, Sivakumar MN, Hisham M, Lakshmikanthcharan S. Traumatic tension pneumopericardium: A rare complication. J Cardiothorac Trauma 2017;2:14-6. [Full text]
Apfelbaum J, Robertson W. Tension Pneumopericardium From Blunt Force Trauma: Resuscitating the Red Baron, in Emergency Physicians Monthly. Bowie, MD, USA; 2018.
Bartolek Hamp D, Letica Brnadić R, Cavrić G, Daraboš N. Occult pneumopericardium after isolated blunt chest trauma. Postgrad Med J 2019;95:343.
Shalaby AA. Pneumopericardium following blunt trauma: Case report. Cir Cardiovasc 2020;27:109-111.
Heimer J, Gascho D, Thali MJ, Schweitzer W. Thoracic trauma in fatal falls from height – Traumatic pneumopericardium correlates with height of fall and severe injury. Forensic Sci Med Pathol 2018;14:188-93.
Demetriades D, Charalambides D, Pantanowitz D, Lakhoo M. Pneumopericardium following penetrating chest injuries. JAMA Surg 1990;125:1187-9.
Nicol AJ, Navsaria PH, Hommes M, Edu S, Kahn D. Management of a pneumopericardium due to penetrating trauma. Injury 2014;45:1368-72.
Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: Clinical implications. JAMA Intern Med 1939;64:913-26.
Adcock JD, Lyons RH, Barnwell JB. The circulatory effects produced in a patient with pneumopericardium by artificially varying the intrapericardial pressure. Am Heart J 1940;19:283-91.
Maurer ER, Mendez FL Jr., Finklestein M, Lewis R. Cardiovascular dynamics in pneumopericardium and hydropericardium. Angiology 1958;9:176-9.
[Table 1], [Table 2], [Table 3], [Table 4]