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Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: a case report

DOI: 10.1186/1752-1947-2-100

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We report a rare case of pneumopericardium with extreme ECG abnormalities after blunt chest trauma in a 22-year-old male. The diagnosis was confirmed using computed tomography (CT) scanning. The case is discussed, together with its differential diagnosis and the aetiology of pneumopericardium and tension pneumopericardium.Pneumopericardium should be distinguished from other pathologies such as myocardial contusion and myocardial infarction because of the possible development of tension pneumopericardium. Early CT scanning is important in the evaluation of blunt chest trauma.When an electrocardiogram (ECG) is obtained during the diagnostic processing and evaluation of a trauma patient (as in the present case), it is important to realize that ECG findings in patients with cardiac trauma are diverse and non-specific. These findings may be non-specific ST-segment or T-wave changes, axis deviation and dysrhythmias, such as premature atrial contractions, bundle branch blocks and ventricular fibrillation [1]. Diagnostic considerations in a patient with blunt chest trauma and ECG abnormalities include, amongst others, myocardial contusion and myocardial ischaemia. Other causes involve the presence of air in thoracic structures that do not normally contain air, for example pneumothorax, pneumomediastinum and pneumopericardium. These options are discussed in a stepwise manner and related to the patient in this case report.A 22-year-old male, with no previous medical history, was admitted to the intensive care unit (ICU) at our hospital with blunt thoracic trauma and near-drowning after a high-energy trauma. The man had been driving a car when, for no apparent reason, he lost control and drove into a ditch filled with water.The patient consequently aspirated water, but managed to reach solid ground. He was transported by ambulance to the hospital emergency unit, where he was found to be in respiratory failure, probably as a result of severe lung contusion. He was subsequently

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