Pneumopericardium and Pneumoperitoneum after Penetrating Chest Injury Moheb A. Rashid, Thore Wikstro ¨m and Per O ¨ rtenwall From the Division of Vascular and Trauma Surgery, Department of Surgery, Sahlgrenska University Hospital/O ¨ stra, Go ¨teborg University, Go ¨teborg, Sweden Eur J Surg 1999; 165: 278–279 INTRODUCTION Pneumopericardium is air in the pericardial cavity with or without tension. It is typically found in premature infants who require positive pressure ventilation (3). Many recent reports have described pneumopericar- dium in adults as a result of penetrating or blunt injuries or after thoracotomy (3, 6). It may or may not be associated with pneumothorax, pneumomediastinum, or subcutaneous emphysema (1). We report a pneu- mopericardium without pneumothorax, pneumome- diastinum, or subcutaneous emphysema but with pneumoperitoneum after a penetrating injury of the lower chest. To the best of our knowledge, this is the first description of such a combination. We describe the clinical characteristics, diagnosis, differential diagno- sis, and management. CASE REPORT A 49-year-old man was assaulted by a group of men, and knocked in the head and abdomen, and stabbed with a knife to the right of the xiphoid process. He was brought immediately to our emergency department. During admission, he had severe pain in the lower chest and the vital signs were stable. On physical examination, he was a little dyspnoeic as a result of the severe pain in the lower chest. There was a diagonal incision 2.5 cm long to the right of the xiphoid process. Because the patient was stable, we performed an emergency computed tomogram (CT) of the chest which showed pneumopericardium (Fig. 1). CT of the upper abdomen showed pneumoperitoneum (Fig. 2), but no bleeding or other abnormalities. He was immediately taken to the operating room and underwent an urgent abdominal exploration. A small haematoma was found over the left liver lobe with a small tear in the liver capsule medial to the falciform ligament. This was not explored. The diaphragm was perforated and the tear was sutured. A gush of air and blood from the incision were frothing in the wound and the pericardium had been penetrated without bleeding Fig. 1. CT of the chest showing pneumopericardium. Fig. 2. CT of the upper abdomen showing pneumoperito- neum in front of the liver at the entry site of the wound. 1999 Scandinavian University Press. ISSN 1102–4151 Eur J Surg 165 CASE REPORT