Pneumopericardium after pneumonectomy and

ABSTRACT Pneumopericardium is a rare condition, most frequently reported in connection with prolonged artificial ventilation in infants with hyaline membrane disease. No reports of pneu-mopericardium after pulmonary surgery have been published. Two cases ofpneumopericardium are reported, one of tension pneumopericardium after pneumonectomy and artificial ventilation and one that followed radical lobectomy and artificial ventilation. The radiographic findings included pneumopericardium and subcutaneous emphysema and the patient who had had a pneumonectomy had severe symptoms of cardiac tamponade. Prolonged artificial ventilation in patients after pul-monary surgery and in the presence of an intrathoracic air leak may be a hazard. The importance of prompt surgical intervention in cases of tension pneumopericardium is underlined; the treatment of choice is thoracotomy with pericardiotomy. Many complications of pulmonary surgery are well known and described and most can be detected from the clinical state of the patient and the chest radio-graph. Pneumopericardium occurring shortly after lo-bectomy or pneumonectomy for cancer is rare, however, and the purpose of this paper is to report two cases of postoperative pneumopericardium, one with and one without tension. Case reports CASE 1 A 65 year old man was treated by right middle and lower lobectomy for a squamous carcinoma located in the right bronchus intermedius. During the first post-operative day he developed total atelectasis of the remaining upper lobe, which was relieved by a ther-apeutic bronchoscopy. On the second day an emergency thoracotomy was performed for suspected bleeding. This operation disclosed no bleeding but recurrence of the atelectasis and a fistula in the bron-chial stump. The bronchus was resutured with inter-rupted polyglycolic acid (Dexon) sutures. The proximal part of the pulmonary artery and the peri