From Big Medical Encyclopedia

PNEUMOPERICARDIUM (pneumopericardium; Greek pneuma air + a pericardium) — accumulation of air and gases in a pericardium. Distinguish the spontaneous and artificial Item.

Spontaneous The item arises at the getting wounds breasts (see) with damage of a pericardium by fire or cold weapon, the fragments of edges, sharp objects getting into a bronchial tube, a gullet and a stomach, aspirating needles, buzha, catheters and drainage tubes, and also owing to break in a cavity of a pericardium of the penetrating ulcers of a gullet, the breaking-up tumors, air cysts and abscesses of the next bodies (bronchial tubes, lungs, a pleura, a gullet, a stomach, a liver and subphrenic space). Gases in a pericardium will be able to be formed and independently as waste product of gas-producing bacteriums at putrefactive processes.

Artificial Items impose for the purpose of differential diagnosis of an exudative pericardis, coelomic cysts, tumors and diverticulums of a pericardium and identification of intra pericardiac unions, and also with to lay down. the purpose — for the prevention of formation of commissures between leaves of a pericardium and removal of pain by stratification of its leaves at a fibrous pericardis, improvements of evacuation of liquid and reduction of speed of its repeated accumulation at exudative pericardis (see).

At detection in a pericardium at the same time of air and blood speak about a hemopneumopericardium (see. Hemopericardium ), air and transudate — about a seropnevmonerikarda, air and pus — about a pyopneumopericardium.

Clinically distinguish the opened, closed and valve Item. The hit of air in a pericardium which is not followed by increase in intra pericardiac pressure as it happens at the opened and closed P. causes in patients only insignificant and quickly passing phenomena — moderate increase of breath and heartbeat, disturbance of a rhythm if there is no other symptomatology caused by the basic disease or an injury which caused the Item.

At valve P. the symptom complex develops as a result of intake of air 6 a pericardium during each systole, especially at cough. As soon as pressure in a pericardium reaches 100 mm w.g. above, patients begin to complain of the feeling of a prelum and pain in heart amplifying at cough. Sharp tachycardia, an asthma and nausea is noted. Become invisible at survey and apical and cordial pushes are not defined to the touch. Perkutorno in the field of cordial dullness comes to light a tympanites with a metal shade, auskultativno — the ringing cardiac sounds heard sometimes at distance; in the presence of B a pericardium of liquid various noise appear: noise of a mill wheel, murmur, ring of hand bells. At the continuing increase in intra pericardiac pressure owing to receipt of new portions of air develops cardiac tamponade (see).

the Roentgenogram of a thorax at a seropnevmonerikarda: in a cavity of a pericardium accumulation of air (1) over a horizontal fluid level (2) is visible, shooters specified a wall of a pericardium.

Diagnosis the wedge, and rentgenol, data is established on the basis. Radiological between heart and pulmonary zero accumulation of air in the form of a light zone («the suspended heart») and the horizontal fluid level (fig.) which is fluctuating at each cordial reduction and displaced at a postural change of the patient is found.

Treatment depends on P.'s character and air volume in a pericardium: at expressed a wedge, the pericardiocentesis is shown to a picture, at a niopnev-monerikarda and a gemopnevmonerikarda — an operative measure.

Forecast usually favorable, in the absence of timely treatment of valve P. it is aggravated.

Bibliography: Astapov B. M. Artificial pneumopericardium, Cardiology, t. 9, No. 3, page 126, 1969; Volynsk 3. M and Gogin E. E. Diseases of a pericardium, page 263, JI., 1964; Gerke A. A. Diseases of a pericardiac bag and their treatment, page 178, M., 1950; Petrosyan Yu. Page and 3 and L. S's N-german. Treatment of a cardiac tamponade and hydrocardia transdermal catheterization, Surgery, No. 8, page 76, 1972; Pirozhenko V. V. An air cardiac tamponade (at perforation of a gullet and a pericardium), Klin, hir., No. 8, page 45, 1968; G about s s and g e A. And., Robertson P. W. a. Stephenson S. F. Spontaneous pneumopericardium, Thorax, V. 4, p. 460, 1976; Khan R. M. Air tamponade and ten-siopneumopericardium, J. thorac. cardio-vasc. Surg., V. 68, p. 328, 1974.

B. B. Zaretsky.