Pediatric Pneumopericardium

Etiology: barotrauma
Imaging: air in pericardial space which does not rise above great vessels and outlines heart / aorta / pulmonary artery, continuous diaphragm sign, subset of pneumomediastinum
Clinical: can cause compromise of venous return -> cardiac tamponade -> death

Radiology Cases of Pneumopericardium

CXR of esophageal perforation from nasogastric tube placement — CXR AP shows air outlining the heart in the pericardial space, air outlining the thymus in the mediastinum, and air in the bilateral pleural spaces.

CXR of pneumopericardium — CXR AP (above) shows a large amount of air around the heart. CXR AP obtained after pericardiocentesis (below) shows a decreased amount of air around the heart and the diaphragm can be continuously traced across the image.

CXR of respiratory syncytial virus pneumonia / RSV — CXR AP and lateral (above) shows right upper lobe collapse and air outlining the inferior border of the heart (continuous diaphragm sign). Left lateral decubitus CXR (below) shows a small right pneumothorax.