A 64 year old man is extubated following surgery for an ankle fracture. He suffers from mild COPD and is now coughing persistently.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is pneumopericardium, pneumomediastinum and surgical emphysema in the neck tissues.
No pneumothorax visible.
Positive pressure ventilation may rarely cause pneumopericardium and (less rarely) pneumomediastinum.
This may or may not be related to the COPD.
Artful observation and the tincture of time is encouraged if possible.
Other proposed causes of pneumopericardium include: post thoracic / cardiac surgery, trauma, pericardio-oesophageal fistula and pericardial infection with gas-forming organisms.