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CT scan showing pneumopericardium with pneumomediastinum, pneumothorax, hemothorax, and pulmonary contusion after severe chest trauma[1]
ICD-10 I31.9, P25.3, S26.8
ICD-9 770.2, 860.1
MeSH D011026

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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Pneumopericardium is a medical condition where air enters the pericardial cavity and a well-recognized clinical and radiologic entity. [2] It can be congenital, or introduced by a wound.

Differential Diagnosis of Underlying Causes


Chest X-Ray

  • The heart partially or completely surrounded by air, with the pericardium sharply outlined by air density on either side.
  • Pneumopericardium can usually be distinguished from pneumomediastinum, since air in the pericardial sac should not rise above the anatomic limits of the pericardial reflexion on the proximal great vascular pedicle. Also on radiographs obtained with the patient in the decubitus position, air in the pericardial sac will shift immediately, while air in the mediastinum will not shift in a short interval between films.
  • Occasionally, it may not be possible to distinguish pneumopenicardium from pneumomediastinum on plain film.





  1. Konijn AJ, Egbers PH, Kuiper MA (2008). "Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: a case report". J Med Case Reports. 2: 100. doi:10.1186/1752-1947-2-100. PMC 2323010. PMID 18394149.
  2. SE Mirvis, M Indeck, RM Schorr, and JN Diaconis. Posttraumatic tension pneumopericardium: the "small heart" sign. Radiology 1986 158: 663-669.

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