Journal of Perioperative Echocardiography

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VOLUME 8 , ISSUE 1 ( January-June, 2020 ) > List of Articles


Pneumomediastinum and Pneumopericardium: Impediment to the Transthoracic Echo Windows

Thanigai Arasu, Sunder Lal Negi, Goverdhan Dutt Puri

Keywords : Cardiac A-lines, COVID-19, Pneumomediastinum, Pneumopericardium

Citation Information : Arasu T, Negi SL, Puri GD. Pneumomediastinum and Pneumopericardium: Impediment to the Transthoracic Echo Windows. J Perioper Echocardiogr 2020; 8 (1):18-20.

DOI: 10.5005/jp-journals-10034-1113

License: CC BY-NC 4.0

Published Online: 19-05-2022

Copyright Statement:  Copyright © 2020; The Author(s).


Aim and objective: To highlight the impediments for the transthoracic echo windows. Background: Pneumomediastinum and pneumopericardium with cardiac A-lines obscuring the transthoracic echo windows. Case description: A 57-year-old male patient with COVID-19 infection underwent tracheostomy and positive pressure ventilation following which he developed pneumomediastinum/pneumopericardium. Subsequently, the apical and parasternal cardiac windows replaced by A-lines hindering the echocardiographic examination. Conclusion: The disappearance of the previously available echo window should raise the suspicion of new-onset pneumomediastinum or pneumopericardium.

  1. Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis 2015;7(Suppl 1):44–49. DOI: 10.3978/j.issn.2072-1439.2015.01.11.
  2. Belleti A, Palumbo D, Zangrillo A, et al. Predictors of pneumothorax/pneumomediastinum in mechanically ventilated covid-19 patients. J Cardiothorac Vasc Anesth 2021;35(12):3642–3651.
  3. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine 1944;23(4):281–358. DOI: 10.1097/00005792-194412000-00001.
  4. Sahni S, Verma S, Grullon J, et al. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci 2013;5(8):460–464. DOI: 10.4103/1947-2714.117296.
  5. Perna V, Vilà E, Guelbenzu JJ, et al. Pneumomediastinum: is this really a benign entity? when it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg 2010;37(3):573–575. DOI: 10.1016/j.ejcts.2009.08.002.
  6. Mansfield PB, Granam CB, Beckwith JB, et al. Pneumopericardium and pneumomediastinum in infants and children. J Pediatr Surg 1973;8(5):691–699. DOI: 10.1016/0022-3468(73)90408-9.
  7. Shah JZ, Kumar SA, Patel AA. Myocarditis and pericarditis in patients with COVID-19. Heart Views 2020;21(3):209–214. DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_154_20.
  8. Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm 2020;17(9):1463–1471. DOI: 10.1016/j.hrthm.2020.05.001.
  9. Reid CL, Chandraratna PAN, Kawanishi D, et al. Echocardiographic detection of pneumomediastinum and pneumopericardium: the air gap sign. J Am Coll Cardiol 1983;1(3):916–921. DOI: 10.1016/s0735-1097(83)80209-5.
  10. Zachariah S, Gharahbaghian L, Perera P, et al. Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. West J Emerg Med 2015;16(2):321–324. DOI: 10.5811/westjem.2015.1.24514.
  11. Allgood NL, Brownlee JR, Green GA. Inability to view the heart through the subxiphoid echocardiographic window: a harbinger of disaster. Pediatr Cardiol 1994;15(1):27–29. DOI: 10.1007/BF00797002.
  12. Md Noor J, Eddie EA. Cardiac A-lines in fast scan as a sign of pneumopericardium. Ultrasound J 2019;11(1):7. DOI: 10.1186/s13089-019-0123-x.
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