Unsuccessful resuscitation of a preterm infant due to a pneumothorax and a masked tension pneumopericardium

Resuscitation. 2008 Aug;78(2):236-9. doi: 10.1016/j.resuscitation.2008.02.025. Epub 2008 May 15.

Abstract

Pneumopericardium is the least common form of air leak in infants. A tension pneumopericardium is even more infrequent but associated with a very high mortality rate. We describe the case of an unsuccessful resuscitation in a preterm infant due to a pneumothorax and tension pneumopericardium. Despite relatively mild pressure ventilation the patient developed massive pulmonary interstitial emphysema. The extra-alveolar air spread from the interstitium towards the mediastinal space (Macklin effect) and caused a pneumothorax and pneumopericardium, which evolved towards a tension pneumopericardium after a traumatic mechanical procedure. The infant deteriorated acutely. Despite prompt pleural drainage there were no signs of recovery at any time. Postmortal examination revealed a tension pneumopericardium and massive interstitial pulmonary emphysema, which was not obvious on radiographical investigation. In cases of acute deterioration of a ventilated neonate, one should always rule out pneumothorax. If the patient does not recover after pleural drainage and cardiac resuscitation a (tension) pneumopericardium should be considered.

Publication types

  • Case Reports

MeSH terms

  • Fatal Outcome
  • Humans
  • Infant, Newborn
  • Male
  • Pneumopericardium / complications
  • Pneumopericardium / therapy*
  • Pneumothorax / complications
  • Pneumothorax / therapy*
  • Pulmonary Emphysema / etiology
  • Pulmonary Emphysema / therapy*
  • Resuscitation / methods*