Ann Thorac Surg 2012;93:e13. doi:10.1016/j.athoracsur.2011.08.083
© 2012 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Portal Venous Air Resulting in Pneumocardia: A Rare Presentation of Intestinal Ischemia
Kara A. Haggerty, BA,
Timothy J. George, MD,
George J. Arnaoutakis, MD,
Claude A. Beaty, MD,
John V. Conte, MD,
Glenn J. Whitman, MD*
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
* Address correspondence to Dr Whitman, Division of Cardiac Surgery, The Johns Hopkins Hospital, 600 N Wolfe St, Blalock 618, Baltimore, MD 21287 (Email: gwhitman{at}jhmi.edu).
| Dr Conte discloses that he has financial relationships with HeartWare and Thoratec.
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A 63-year-old man with advanced ischemic cardiomyopathy was admitted in fulminant heart failure. His heart failure worsened despite maximal inotropic and intraaortic balloon pump support, necessitating placement of a left ventricular assist device. His immediate postoperative course was complicated by right heart failure and subsequent renal and hepatic dysfunction. His subsequent postoperative course was complicated by multiple episodes of sepsis secondary to pneumonia. On postoperative day 191 the patient went into septic shock. A computed tomographic scan of his chest, abdomen, and pelvis revealed substantial air (white arrows) in the right atrium and ventricle (Fig 1A), portal venous air (Fig 1B), and severe, diffuse pneumatosis intestinalis (Fig 1C). The patient subsequently expired. To our knowledge, there is only one other reported case of pneumocardia associated with pneumatosis intestinalis [1]. These images portray this exceedingly rare and catastrophic complication of intestinal ischemia.
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References
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- Tichauer M, Sakpal SV, Chamberlain RS. Right ventricular pneumocardia secondary to hepatic abscesses Case Rep Gastroenterol 2010;4:498-501.[Medline]
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