What Is Pneumopericardium?

Medically Reviewed by James Beckerman, MD, FACC on February 11, 2024
3 min read

Pneumopericardium is a rare condition that affects the sac around your heart. It normally goes away on its own but can sometimes lead to life-threatening complications. 

Pneumopericardium happens when you have air or gas in the pericardium. The pericardium is the tissue sac around your heart. The sac is filled with fluid that lubricates your heart and protects it from infection. The sac keeps your heart contained in your chest wall and stops it from over-expanding when blood volume increases. This helps keep your heart working properly.

Pneumopericardium can be classified as simple, with only gas and air in the fluid, or complicated, with gas, air, pus, and other fluids in the sac. In most cases, pneumopericardium goes away on its own and doesn’t need to be treated, though your doctor will want to monitor it. 

Pneumopericardium can happen for lots of different reasons. In most cases, it’s caused by a dull or blunt injury to the chest. The injury can come from:

Other pneumopericardium causes include:

  • Gas in the abdominal cavity 
  • Lung diseases like asthma or cystic fibrosis that can cause air outside the lungs
  • Lung diseases that cause air in the space between your lungs, called the mediastinum 
  • Too much lung pressure that can cause air outside the lungs
  • Complications from heart or lung surgery
  • Infection in the pericardium
  • Some syndromes present at birth
  • Fistulas, or irregular connections between the pericardium and an area that holds gas, like your windpipe

Pneumopericardium can cause pain and shortness of breath. Not everyone has symptoms of pneumopericardium, though.

In some cases, pneumopericardium can lead to a life-threatening complication called cardiac tamponade in which extra air builds up around your heart. The air puts pressure on your heart and stops it from working properly. Symptoms come on fast and include:

This complication is a medical emergency and you’ll need treatment right away.

Your doctor will ask about your past medical history and do a physical exam. They’ll listen to your heart and lungs and take your blood pressure, which might be lower than normal. They’ll also check for pneumopericardium with radiology or imaging tests. These might be:

In most cases, pneumopericardium gets better on its own and doesn’t need treatment. Your doctor will monitor your blood pressure and your heart’s electrical rhythms. If there are other problems causing pneumopericardium like lung diseases, your doctor will treat those. 

Cardiac tamponade needs immediate treatment, though. The most common treatment for this complication is pericardiocentesis. This is where your doctor inserts a long, narrow tube called a catheter into your pericardial sac and draws out the air. This is usually an emergency treatment. 

In other cases, your doctor might do surgery to drain the fluid and remove some of the pericardium. This is called a pericardial window, and it can prevent the air from building up. In rare cases, your doctor might place a chest tube to help keep air draining. 

If pneumopericardium complications like cardiac tamponade are treated quickly, there usually aren’t any other problems. 

If these complications are left untreated, though, you can go into shock. This happens when your circulatory system can’t pump enough blood and oxygen through your body. This can cause serious health problems like organ failure and even death.