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Definition.—Pneumo-pericardium is an accumulation of air in the pericardium.

Etiology.—The presence of air or gas in the pericardium is a rare disease, and occurs by the establishment of communication with the air, either through diseased processes, such as cancerous or tubercular ulceration or through injuries; thus a ruptured pulmonary cavity might result in this condition, or the perforation of the esophagus by malignant processes would give rise to this lesion. Sometimes pus in the pericardium will generate gas, and consequently be a causal factor.

Pathology.—Pneumo-pericardium, pure and simple, seldom, if ever, occurs, and is a combination of air and pus, air and serum, or air and blood, and should properly be termed pyo-pneumo-pericardium, seropneumo-pericardium, and hemo-pneumo-pericardium. Not infrequently pericarditis is set up as a complication.

Symptoms.—The symptoms of this affection are similar to those of pericarditis with effusion, and can only be distinguished from the latter by the physical signs. The pericardium is distended, and percussion reveals dullness and resonance according to the amount of air and fluid present. These sounds change with change of position.

Auscultation reveals a splashing or metallic sound, due to the movements of the heart in the fluid and gaseous contents of the pericardium. These are quite pronounced, and sometimes may be heard without placing the ear to the chest.

If pericarditis exists, the friction sound may also be heard. The pulse is weak and the dyspnea is a marked feature. The disease is usually of short duration, terminating generally in death.

Diagnosis.—By careful attention to the physical signs already mentioned, the condition can usually be recognized.

Prognosis.—The prognosis is nearly always unfavorable, owing to the nature of the disease giving rise to it.

Treatment.—The treatment will be about the same as that recommended for pericarditis and hemopericardium, though but little hope may be entertained in this disease. The pericardium should be punctured with an aspirating needle or small trocar, which will give temporary relief.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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