Pneumopericardium after major trauma.

CASE REPORT A 20-year-old male, after falling from 15 meters, reported a major trauma that consisted with hemorrhagic shock, PNX and pneumopericardium, lung contusions, retroperitoneal bleeding, lumbar vertebral fractures, leg and arm multiple fractures. The patient, in emergency room, was intubated and submitted to first-line diagnostic evaluation for major trauma that revealed a negative for intra-abdominal bleeding FAST, and a negative for PNX thorax Rx. Because an episode of hypotension and hypoxemia with reduction of breathing sound in right thorax, a chest drainage tube was inserted in midclavear line on the second intercostal space. The maneuver was successful and the symptoms were reduced. But, during computed tomography scan evaluation, the patient developed a new hypotension, hypoxemia, edema and cyanosis of the neck and superior thorax, and jugular veins over distension. The computed tomography scan of thorax revealed a tension PNX and pneumopericardium (Fig. 1). Therefore, the physician inserted a tube in the fifth intercostals space in axillary line that resolved the PNX and the pneumopericardium too (Fig. 2).