Illustration of air surrounding a heart in a translucent sac, symbolizing pneumopericardium.

Pneumopericardium After Pericardiocentesis: A Rare Complication Explained

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Understanding the causes, symptoms, and management of pneumopericardium following pericardiocentesis"

Pneumopericardium, characterized by the presence of air within the pericardial sac, is a condition that can arise from both spontaneous and iatrogenic (treatment-related) causes. While relatively uncommon, it's crucial to recognize due to its potential to complicate patient care and mimic other serious conditions.

The telltale sign of pneumopericardium on a chest X-ray is the presence of an air-fluid level, along with a radiolucent halo of air surrounding the heart, delineated by the pericardial sac. The clinical course of iatrogenic pneumopericardium is often self-limiting, meaning it resolves on its own without specific interventions. However, vigilance is required to ensure that no severe complications develop.

This article delves into a specific instance of iatrogenic pneumopericardium, observed in a young patient who underwent pericardiocentesis as a treatment for tuberculous pericardial effusion. Understanding such cases is vital for medical professionals and patients alike.

What Happens During Pneumopericardium?

Illustration of air surrounding a heart in a translucent sac, symbolizing pneumopericardium.

Let's consider the case of a 20-year-old man who was admitted to the hospital with significant pericardial effusion, a condition where fluid accumulates around the heart. His medical history included pulmonary tuberculosis, for which he had been undergoing treatment for eight months. Upon examination, his vital signs were relatively stable, with a blood pressure of 131/65 mmHg, a pulse rate of 92 bpm, a respiratory rate of 26 per minute, and a body temperature of 36.5°C.

Chest radiographs revealed an enlarged heart shadow, while an echocardiogram confirmed a large pericardial effusion and collapse of the right atrium. The left ventricular ejection fraction, a measure of the heart's pumping efficiency, was estimated at 60%. To alleviate the fluid buildup, a subxiphoid pericardiocentesis was performed, draining over 1,000 mL of serous fluid over 12 hours. This intervention successfully relieved the patient's dyspnea (shortness of breath).

Fluid Analysis: Sputum and pericardial fluid cultures came back negative for AFB and other organisms.
Pericardial Fluid Composition: The fluid was lymphocyte dominant with protein at 6.5 g/dL, albumin at 3.6 g/dL, lactate dehydrogenase at 466 U/L and white blood cell count was 7,200 cells/µL (84% lymphocytes).
Infections Screenings: Polymerase chain reaction for Mycobacterium tuberculosis deoxyribonucleic acid was negative with pericardial fluid and adenosine deaminase in pericardial effusion was 96 IU/L (normal, 5 to 23 IU/L).

Five days post-pericardiocentesis, the patient reported pleuritic chest pain. A follow-up chest radiograph revealed a new radiolucent outline around the heart, indicating air accumulation in the pericardial space. Echocardiography showed a small amount of pericardial effusion, bright echogenic spots swirling in the pericardial cavity, but no tamponade. The patient was treated conservatively, the drainage catheter was removed, and the symptoms gradually resolved over five days. The patient also received steroids and anti-tuberculosis therapy.

Key Takeaways for Managing Pneumopericardium

This case underscores that pneumopericardium, while rare, can occur following pericardiocentesis due to factors like leaky drainage systems or direct communication between the pleura and pericardium. Early diagnosis through chest radiographs and echocardiography is crucial. Although many cases resolve with conservative management, prompt recognition and appropriate treatment strategies are key to preventing serious complications and ensuring positive patient outcomes.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.4070/kcj.2011.41.5.280, Alternate LINK

Title: Pneumopericardium As A Complication Of Pericardiocentesis

Subject: Cardiology and Cardiovascular Medicine

Journal: Korean Circulation Journal

Publisher: The Korean Society of Cardiology

Authors: Woo Hyung Choi, You Mi Hwang, Mi Youn Park, Seung Jae Lee, Hye Yeon Lee, Sei Won Kim, Byoung Yeon Jun, Jin Soo Min, Woo Seung Shin, Jong Min Lee, Yoon Seok Koh, Hui-Kyung Jeon, Wook Sung Chung, Ki-Bae Seung

Published: 2011-01-01

Everything You Need To Know

What is pneumopericardium, and why is it a concern after pericardiocentesis?

Pneumopericardium is a condition characterized by air accumulation within the pericardial sac, the space surrounding the heart. It's a concern after pericardiocentesis because, although rare, it can complicate patient care. It can mimic other serious conditions and requires careful monitoring to prevent potential complications. While the clinical course of iatrogenic pneumopericardium is often self-limiting, vigilance is key.

How is pneumopericardium typically diagnosed following pericardiocentesis, and what are the key indicators to look for?

Pneumopericardium is typically diagnosed using chest radiographs, where the telltale sign is an air-fluid level, along with a radiolucent halo of air surrounding the heart, delineated by the pericardial sac. Echocardiography can also be used, as demonstrated in the case of the 20-year-old man, where bright echogenic spots swirling in the pericardial cavity were observed. These diagnostic tools help in the early recognition of pneumopericardium and are crucial for prompt management.

In the case of the 20-year-old man, what specific factors contributed to the development of pneumopericardium after his pericardiocentesis?

In the presented case, the 20-year-old man developed pneumopericardium five days post-pericardiocentesis. While the exact cause isn't explicitly stated, the factors typically contributing to pneumopericardium after pericardiocentesis include leaky drainage systems or direct communication between the pleura and pericardium. The patient's prior condition of pulmonary tuberculosis and subsequent pericardial effusion requiring pericardiocentesis likely increased the risk, creating a scenario where air could enter the pericardial space during or after the procedure.

What conservative management strategies are typically employed in cases of pneumopericardium following pericardiocentesis, and how effective are they?

Conservative management strategies for pneumopericardium often involve close observation, removal of the drainage catheter, and supportive care. In the case of the 20-year-old man, the patient was treated conservatively, and the symptoms gradually resolved over five days. While many cases of iatrogenic pneumopericardium are self-limiting and resolve with conservative management, it's crucial to monitor patients for any signs of complications, such as cardiac tamponade or infection. The effectiveness of conservative management depends on the severity of the pneumopericardium and the patient's overall condition.

What are the potential long-term implications of pneumopericardium after pericardiocentesis, and how can medical professionals mitigate these risks to ensure positive patient outcomes?

While pneumopericardium often resolves with conservative management, potential long-term implications can include recurrent pericardial effusions, constrictive pericarditis, or infection. To mitigate these risks, medical professionals should ensure early diagnosis through chest radiographs and echocardiography, employ appropriate treatment strategies, and closely monitor patients for any signs of deterioration. Addressing underlying conditions, such as tuberculosis, with therapies like steroids and anti-tuberculosis medications, is also crucial for ensuring positive patient outcomes and preventing long-term complications.