A 71-year-old female with lung adenocarcinoma underwent surveillance PET/CT, which revealed new central necrotic cavitation of a preexisting left lower lobe mass, with communication between this air-filled cavity and the left mainstem bronchus, as well as pericardial effusion with large pneumopericardium, consistent with malignant bronchopericardial fistula (Fig. 1). Echocardiography and physical examination confirmed tamponade. Bronchoscopic debulking showed a necrotic tumour cavity. During pericardiocentesis, air in the pericardial space was conspicuous fluoroscopically (Video 1). Intra-pericardial pressure was 11 mm Hg, 1500 ml of seropurulent fluid was removed. Fluid cultures were positive for Staphylococcus aureus. Her rest dyspnoea improved and she was discharged to hospice care.
Pneumopericardium is known to cause cardiac tamponade  in trauma patients or newborn infants requiring positive pressure ventilation. Fistulas such as between the oesophagus, stomach, or lung [2, 3] and pericardium have been reported. The unique images and video presented are illustrative of this interesting disease entity.
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Conflict of interest
T. M. Frisoli, T. Jain, T. Swadia, X. Hong and M. Guerrero declare that they have no competing interests.
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Frisoli, T.M., Jain, T., Swadia, T. et al. Cardiac tamponade due to pyopneumopericardium from malignant bronchopericardial fistula. Neth Heart J 25, 348–349 (2017). https://doi.org/10.1007/s12471-017-0961-8
- Staphylococcus Aureus
- Trauma Patient
- Lung Adenocarcinoma
- Newborn Infant
- Pericardial Effusion