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Logo of archdischfnArchives of Disease in Childhood - Fetal & NeonatalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child Fetal Neonatal Ed. 2007 May; 92(3): F168.
PMCID: PMC2675322

Pneumopericardium in a term infant on nasal continuous positive airway pressure

We report neonatal pneumopericardium in a term infant with gestational age of 39 weeks. The pneumopericardium developed during the second day of postnatal age. There was no evidence of other forms of air‐leak. The infant was treated with nasal CPAP delivered for respiratory distress and was not mechanically ventilated before pneumopericardium occurred. His plain chest radiograph showed a halo of air around the heart (fig 11).). In the case there was no clinical evidence of cardiac air tamponade and the pneumopericardium resolved spontaneously. The next day, control chest radiograph and echocardiogram showed complete resolution of the pneumopericardium.

figure fn107458.f1
Figure 1 Chest x ray film showing a radiolucent halo around the heart in a 2‐day‐old infant with pneumopericardium.

Pneumopericardium is a rare form of neonatal air‐leak syndrome with high morbidity and mortality. It is almost invariably preceded by other forms of air‐leak.1 Neonatal pneumopericardium is usually a complication of positive‐pressure ventilation in premature infants with respiratory distress.2 The mechanism by which pneumopericardium is not well understood, but it is probably due to passage of air along vascular sheaths. The clinical signs of pneumopericardium range from asymptomatic to the full picture of cardiac tamponade. Asymptomatic patients should be observed closely with chest radiograph but symptomatic patients should be treated emergently by pericardiocentesis.


Competing interests: None declared.


1. Alpan G, Goder K, Glick B. et al Pneumopericardium during continuous positive airway pressure in respiratory distress syndrome. Crit Care Med 1984. 121080–1081.1081 [PubMed]
2. Burt T B, Lester P D. Neonatal pneumopericardium. Radiology 1982. 14281–84.84 [PubMed]

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