Background: Pneumopericardium, the presence of air within the pericardial space, is a rare occurrence which usually follows positive pressure ventilation in infants, or blunt and penetrating thoracoabdominal injuries in adults. The occurrence of iatrogenic pneumopericardium following tube thoracostomy is an extremely rare occurrence.
Case presentation: We present a rare case of iatrogenic pneumopericardium in a 1 year and 7 months old female child for whom a left side tube thoracostomy was done using nasogastric tube for an indication of left empyema thoracis. Later, she developed progressive worsening of shortness of breath and imaging revealed iatrogenic pneumopericardium. She was managed conservatively and discharged home in good condition.
Discussion: Pneumopericardium can have a range of presentations from being asymptomatic to presenting with features of cardiac tamponade. Treatment can range from conservative observation to pericardiocentesis and insertion of a small chest tube into the pericardium. In the absence of echocardiographic evidence of tamponade, the severe malnutrition our patient had and the already infected pleural cavity which could have increased her postoperative complication we deferred surgical intervention.
Conclusion: Iatrogenic pneumopericardium is a rare event but it might lead to death if not diagnosed and treated promptly. Although reporting of complications is not popular, this represents an opportunity to advance the safety during chest drain insertion. The tendency to develop tension pneumopericardium urging surgical intervention is high in pediatric patients but our patient has improved well with conservative management.