Acute tension pneumopericardium due to perforated gastric ulcer without diagnostic radiographic findings 72 h before perforation

Introduction: Acute tension pneumopericardium due to gastric perforation is a rare and often lethal condition. Only a few case reports have been described in the literature. Diagnosis based on clinical evaluation is difficult and it is usually made incidentally upon computed tomography (CT) or plain radiography of the chest. Since cardiac tamponade caused by pneumopericardium is life-threatening, immediate diagnosis and emergent therapy is vital.

Case report: We report a 75-year-old male with peptic ulcer disease associated with perforation of the pericardium and acute shock. It is the first reported case with a series of two computed tomograms performed during the 72 h preceding the acute onset of tension pneumopericardium. No radiographic evidence of ulcer perforation was present in the three days prior to the acute event.

Discussions: Gastric ulcer perforation into the pericardium is rare and could not be detected by CT scan prior the deletorious event. Pneumopericardium seems to be fateful and could not be foreseen by clinical or radiological findings.<Learning objective: Pericardial air tamponade due to ulcer Perforation is a very rare reason for cardiogenic shock. It could not be foreseen by CT scan.>.