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A Rare Case of Pneumo-Pericardium and Pneumothorax After Left Nephrectomy
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A5342 - A Rare Case of Pneumo-Pericardium and Pneumothorax After Left Nephrectomy
Author Block: J. Margapuri; Medicine, James J Peters VA Medical Center, Bronx, NY, United States.
TITLE:
ABSTRACT INTRODUCTION: Pneumothorax and pneumo-pericardium occurring simultaneously after abdominal surgery are very rare.
Authors: Primary: Jyothi Margapuri, MD; Secondary: Hasan Saiyed, MD; Gregory
Schilero, MD, Siegel Robert, MD, Bachan Moses MD, Zinobia Kahn, MD.
CASE: A 69 year-old man with past medical history of hypothyroidism, squamous cell carcinoma of hard palate, status post resection, recurrent mantle cell lymphoma stage III, status post six cycles of CHOP regimen with Rituximab, left 4cm cystic renal mass, was admitted to surgical intensive care unit (SICU) s/p robotic left partial nephrectomy. His pre-operative chest- x ray was normal. Patient was intubated in the OR and extubated before admission to SICU. The procedure was uneventful. Post-operative chest x ray showed a new moderate/large pneumo-pericardium with moderate sized left lateral pneumothorax. Electrocardiogram showed low voltage in the QRS leads and bed side ultrasound showed mild fluid in the pericardium. He was hemodynamically stable and saturating well on non-rebreather (NRB) mask. Physical examination revealed distant heart sounds and decreased breath sounds on left side of the chest. He denied any chest pain, shortness of breath, palpitations and other complaints. He patient remained hemodynamically stable and was titrated of NRB mask to nasal cannula. Serial chest x-rays showed improvement of pneumo-pericardium and pneumothorax and subsequently they resolved spontaneously. Echocardiogram showed normal studies.
DISCUSSION: The present case demonstrates the instructive points about post-surgical complications and their acute management. Pneumothorax commonly occur after venous access on the ipsilateral side to the puncture. But both pneumothorax and pneumo-pericardium are very uncommon. Pericardial perforation resulting in tamponade is extremely rare which can lead to serious complications that may require percutaneous drainage or even open heart surgery if pericardial effusion is large. In our case the air that was used for surgery tracked up the fascial plane via the mediastinum, possible secondary to a defect.
CONCLUSION: Extra vigilance is needed in post-surgical patients with rare complications like pneumo-pericardium with pneumothorax as in this case. It is important to be aware of this potential morbidity to prevent life threatening complication which may require acute surgical intervention in some. Our patient was hemodynamically stable and pneumothorax and pneumo-paricardium cleared without surgical intervention.
Author Block: J. Margapuri; Medicine, James J Peters VA Medical Center, Bronx, NY, United States.
TITLE:
ABSTRACT INTRODUCTION: Pneumothorax and pneumo-pericardium occurring simultaneously after abdominal surgery are very rare.
Authors: Primary: Jyothi Margapuri, MD; Secondary: Hasan Saiyed, MD; Gregory
Schilero, MD, Siegel Robert, MD, Bachan Moses MD, Zinobia Kahn, MD.
CASE: A 69 year-old man with past medical history of hypothyroidism, squamous cell carcinoma of hard palate, status post resection, recurrent mantle cell lymphoma stage III, status post six cycles of CHOP regimen with Rituximab, left 4cm cystic renal mass, was admitted to surgical intensive care unit (SICU) s/p robotic left partial nephrectomy. His pre-operative chest- x ray was normal. Patient was intubated in the OR and extubated before admission to SICU. The procedure was uneventful. Post-operative chest x ray showed a new moderate/large pneumo-pericardium with moderate sized left lateral pneumothorax. Electrocardiogram showed low voltage in the QRS leads and bed side ultrasound showed mild fluid in the pericardium. He was hemodynamically stable and saturating well on non-rebreather (NRB) mask. Physical examination revealed distant heart sounds and decreased breath sounds on left side of the chest. He denied any chest pain, shortness of breath, palpitations and other complaints. He patient remained hemodynamically stable and was titrated of NRB mask to nasal cannula. Serial chest x-rays showed improvement of pneumo-pericardium and pneumothorax and subsequently they resolved spontaneously. Echocardiogram showed normal studies.
DISCUSSION: The present case demonstrates the instructive points about post-surgical complications and their acute management. Pneumothorax commonly occur after venous access on the ipsilateral side to the puncture. But both pneumothorax and pneumo-pericardium are very uncommon. Pericardial perforation resulting in tamponade is extremely rare which can lead to serious complications that may require percutaneous drainage or even open heart surgery if pericardial effusion is large. In our case the air that was used for surgery tracked up the fascial plane via the mediastinum, possible secondary to a defect.
CONCLUSION: Extra vigilance is needed in post-surgical patients with rare complications like pneumo-pericardium with pneumothorax as in this case. It is important to be aware of this potential morbidity to prevent life threatening complication which may require acute surgical intervention in some. Our patient was hemodynamically stable and pneumothorax and pneumo-paricardium cleared without surgical intervention.
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