Ann Thorac Surg 2008;85:664. doi:10.1016/j.athoracsur.2007.03.075
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Pneumopericardium 3 Years After Lung Cancer Surgery
Akito Imai, MD,
Shigemi Ishikawa, MD*,
Ryota Nakamura, MD,
Yukinobu Goto, MD,
Mitsuaki Sakai, MD,
Masataka Onizuka, MD,
Yuzuru Sakakibara, MD
Department of Chest Surgery, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Japan
* Address correspondence to Dr Ishikawa, University of Tsukuba, Graduate School of Comprehensive Human Science, Department of Chest Surgery, Tennoudai, Tsukuba-Shi, Ibaraki, 305-8575, Japan (Email: ishikawa{at}md.tsukuba.ac.jp).
A 77-year-old man was referred to our respiratory surgery department with complaints of dyspnea, which had been aggravated during the previous 10 days. He had had a left lower lobectomy combined with a lingular segmentectomy for lung cancer 44 months earlier. Pathologic examination revealed T2N1M0 (stage IIB) squamous cell carcinoma of the left lower lobe that had invaded the lingular segment. His postoperative course was uneventful. His vital signs on admission were a pulse rate of 72 beats per minute, blood pressure of 120/70 mm Hg, respiratory rate of 22 breaths per minute, and temperature of 36.9°C. An electrocardiogram showed no particular abnormality. A chest x-ray film (anteroposterior view) showed a descended left apical pleura (Fig 1,
arrowheads) and an obliterating linear shadow (Fig 1, arrows) in the left lower field that had not been previously recognized. A computed tomographic scan of the chest confirmed left pneumothorax and pneumopericardium without mediastinal emphysema (Fig 2). Sequential coronal views of the chest, reconstructed by means of multiplanar reformation of computed tomography, showed communication between the left pleural and pericardial space along with the left main-stem pulmonary artery (Fig 3,
arrow). Although the left lung had not completely collapsed because of postoperative adhesion in the left pleural cavity, increased intrathoracic pressure was believed to have caused a pericardial tear around the lung hilus resulting in pneumopericardium. A percutaneous drainage tube was inserted into the pneumothorax that resulted in the gradual resolution of these symptoms. Air leakage diminished soon after, which was not continuous. A follow-up chest computed tomographic scan 4 days after chest drainage revealed definite improvement of both the pneumothorax and pneumopericardium. The chest drainage tube was removed. The patient was discharged 3 days after chest tube removal. He was well at his 3-month follow-up.
