Traumatic Tension Pneumopericardium

Tension pneumopericardium is a rare and life threatening condition which results from either penetrating or blunt thorax trauma. A 44-year-old man, who fell from the fifth floor of a building, had major trauma that consisted with hemorrhagic shock, pneumothorax and pneumopericardium, retroperitoneal hemorrhage, pelvic and lower extremity fractures. Multiple costal fractures, sternal fracture, right hemopneumothorax, massive air in the pericardial sac and diffuse subcutaneous emphysema were reported in the chest computed tomography. Pneumopericardium is usually self–limited but can progress into tension pneumopericardium causing cardiac tamponade. The drainage of pneumothorax could be the initial procedure in case of pneumothorax associated with pneumopericardium. However, emergent pericardiocentesis can be required for patients with resistant hypotension. Emergency physicians should consider this rare entity for the differential diagnosis of thorax trauma with shock and be familiar with its treatment options.