[Traumatic pneumopericardium with cardiac tamponade].

A 20 year old male motorist with multiple injuries, including bilateral lung laceration, developed cardiac tamponade 12 hours after injury. X-ray showed characteristic findings of pneumopericardium with air all around the cardiac silhouette, which was diminished in size. A chest tube was inserted intrapericardially through a subxiphoid incision. Blood pressure increased immediately, and central venous pressure became normal. Cardiac left ventricular stroke work increased by 86% to normal value. The drain was removed after three days. Another patient was a 15 year old male cyclist who had been overrun by a trailer. Left-sided emergency thoracotomy was performed during laparotomy for liver and vena cava injury, in the course of which procedures there was a sudden decrease in blood pressure with marked elevation of the central venous pressure. The pericardium was incised. Air hissed out, leading to normalisation of arterial and venous pressures. Both patients recovered. Pneumopericardium without symptoms may be treated by observation. Tension pneumopericardium is rare and is best treated by open drainage.