Giannopoulou Eleni, Tsilivarakis Damianos, Kosmopoulou Stavroula, Lazaros George
Department of Cardiology, General Hospital of Kalamata, Kalamata, GRC.
Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2025 May 2;17(5):e83356. doi: 10.7759/cureus.83356. eCollection 2025 May.
Spontaneous pneumomediastinum and pneumopericardium, two rare conditions, are mainly described in patients with underlying respiratory illnesses. We present the case of a healthy 21-year-old male who developed these conditions abruptly after a single episode of coughing. Possibly, it was provoked by an increase in intra-alveolar pressure which caused alveolar rupture and air dissemination along the bronchovascular sheath and into the pericardial sac via vulnerable areas. These events led to sustained symptomatology, which prompted the patient to seek medical referral. The presence of air within the mediastinum and pericardium was associated with characteristic auscultatory findings, known as "Hamman's sign," and echocardiographic findings, referred to as the "air gap sign." The condition was diagnosed using a thoracic X-ray, which demonstrated a distinct dark line extending from the level of the left pulmonary artery along the left cardiac contour, curving around its border, a finding consistent with free air in the mediastinum and pericardium. This was subsequently confirmed by thoracic computed tomography. The condition was self-limiting. The patient quickly became asymptomatic, and his vital signs remained normal. No complications or hemodynamic compromise occurred, and he did not require any special medical treatment other than adequate oxygenation. After close monitoring via telemetry and blood examinations, discharge was decided on the third day, following a repeat X-ray, which revealed complete resolution. A follow-up chest radiograph and transthoracic echocardiogram performed two weeks later showed no pathological findings.
自发性纵隔气肿和心包积气是两种罕见病症，主要见于患有基础呼吸系统疾病的患者。我们报告一例健康的21岁男性病例，该患者在单次咳嗽发作后突然出现了这些病症。可能是肺泡内压力升高引发了这一情况，导致肺泡破裂，空气沿支气管血管鞘扩散，并通过薄弱区域进入心包腔。这些情况导致了持续的症状，促使患者寻求医疗转诊。纵隔和心包内存在空气与特征性的听诊表现（即“哈曼征”）及超声心动图表现（即“气隙征”）相关。通过胸部X线检查诊断出了该病症，X线显示一条清晰的黑线从左肺动脉水平沿左心轮廓延伸，绕过其边界，这一表现与纵隔和心包内的游离气体相符。随后胸部计算机断层扫描证实了这一诊断。该病症具有自限性。患者很快就没有症状了，生命体征保持正常。未发生并发症或血流动力学损害，除了给予充足的氧疗外，他不需要任何特殊治疗。通过遥测和血液检查进行密切监测后，在第三天进行了复查X线，显示完全消退，随后决定让患者出院。两周后进行的胸部X线复查和经胸超声心动图检查未发现病理结果。
