# Iatrogenic Pneumopericardium After Pericardiocentesis: A Systematic Review and Case Report

## TL;DR

This paper reports a rare case of air in the heart sac after a medical procedure and reviews similar cases to highlight the importance of proper diagnosis and treatment.

## Contribution

The study presents a new case and systematic review of iatrogenic pneumopericardium after pericardiocentesis, emphasizing diagnostic challenges and management.

## Key findings

- 37 cases of pneumopericardium after pericardiocentesis were reviewed, with 51.6% showing cardiac tamponade.
- Catheter drainage system issues were the main cause in 64.9% of cases.
- Transthoracic echocardiography is unreliable for diagnosis, while chest X-ray and CT are more definitive.

## Abstract

Background: Pneumopericardium is the presence of air within the pericardial cavity. We report a case of iatrogenic pneumopericardium following pericardiocentesis in a patient with primary cardiac angiosarcoma. Additionally, we provide a systematic review of pericardiocentesis-associated pneumopericardium to offer a comprehensive overview and evaluate the role of echocardiography in its diagnosis. Methods: The PubMed database was searched from inception until January 2025 to perform a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate articles on iatrogenic pneumopericardium following pericardiocentesis published in the English language. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was used to appraise the included case reports. Results: Of the 108 search results obtained, after screening and a backward citation search, 37 articles were selected for inclusion in this review, accounting for a total of 37 patients. According to the JBI Critical Appraisal Checklist for Case Reports, 7 case reports were of high quality and 12 of low quality. The overall evidence of quality of the case reports was moderate, and 51.6% of patients developed hemodynamic compromise or showed signs of cardiac tamponade. The main underlying cause for the development of pneumopericardium was issues relating to the catheter drainage system; 64.9% of cases required decompressive therapy. Conclusions: Pneumopericardium can occur as a complication after pericardiocentesis and must therefore be considered in symptomatic patients. While detection by transthoracic echocardiography is difficult and relies on non-validated signs, chest X-ray and computed tomography can provide a definitive diagnosis.