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Ann Thorac Surg 2002;74:241-243
© 2002 The Society of Thoracic Surgeons

Case report

Pyopneumopericardium caused by mediastinal granuloma

Lorne J. Gula, MD, FRCPC*a, Richard A. Malthaner, MD, FRCSCb, Mackenzie A. Quantz, MD, FRCSCc

a Division of Cardiology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
b Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
c Division of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada

Accepted for publication October 17, 2001.

* Address reprint requests to Dr Quantz, London Health Sciences Centre, University Campus, Room 4-TU32, 339 Windermere Rd, London, ON N6A 5A5, Canada
e-mail: maquantz{at}julian.uwo.ca

We report the case of a previously healthy 32-year-old man who was seen with flulike symptoms, dyspnea, and chest pain. The diagnosis was pyopneumopericardium, and pericardial tap revealed 1.3 L of purulent material. Computed tomography of the chest demonstrated a calcified mass inferior to the carina. Urgent exploration through a right thoracotomy revealed that the mass was adherent to the esophagus and pericardium. The subcarinal mass was resected. Pathological study demonstrated granulomatous lymph nodes, which were likely due to histoplasmosis. This is among the first reports of granulomatous erosion into the pericardium causing pyopneumopericardium. The patient made a good recovery, and his case demonstrates the importance of early imaging and mediastinal exploration for pyopneumopericardium. cardiac tamponade, esophageal fistula, granuloma, histoplasmosis, pyopneumopericardium, pneumopericardium






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Copyright © 2002 by The Society of Thoracic Surgeons.