Spontaneous pneumopericardium an unusual complication in a patient of HIV and pulmonary tuberculosis
A 30-year-old HIV-positive male smoker on antiretroviral therapy (ART) presented with complaints of cough with expectoration and fever for two and a half months. Cough was moderate in intensity and was present throughout the day with worsening at night. Expectoration was thick, whitish in color, and nonfoul smell. Patient had intermittent fever with an evening rise. There were associated complaints of decreased appetite and loss of weight. There was no history of dyspnea, chest pain, or vomiting. There was no history of trauma or preexisting respiratory or cardiac disease. There was no history of any procedure in the past.\nClinical examination of the patient showed stable vitals. Pulse rate was 102/min and was regular, synchronous, and good volume. BP was 110/70 mm of Hg and temperature was 99.2°F with a respiratory rate of 20/min. Oral sores were present. Chest examination revealed bilateral coarse crepitations in bilateral infra-clavicular and mammary areas. Cardiac examination was normal. There was no murmur and there were no signs of cardiac tamponade.\nRoutine laboratory investigations were within normal limits. Erythrocyte sedimentation rate (ESR) was 98 mm in first hour. Sputum examination was positive for acid fast bacilli (AFB). Electrocardiogram (ECG) showed normal sinus rhythm.\nX-ray chest revealed patchy infiltration in bilateral upper zones. A thin hyper-lucent line was present lining the lateral cardiac borders suggesting possibility of pneumopericardium []. The air or gas in X-ray chest did not rise above the upper level of pericardium in standing erect position differentiating it from pneumothorax and pneumomediastinum. There was no evidence of cardiomegaly. Computed tomography (CT) scan of the chest confirmed the presence of pneumopericardium []. There was no peumomediastinum or pericardial effusion. It also showed a well-defined thick walled cavity with necrotic areas in apicoposterior segment of left upper lobe and bilateral infiltration with minimal bronchiectatic changes [].\nBarium swallow fluoroscopy ruled out any esophagopericardial fistula. The patient did not have any symptoms related to pneumopericardium and its detection was purely incidental. Patient was started on anti-tubercular treatment (ATT) as per the guidelines of revised national tuberculosis control program. Patient showed clinical improvement after 4 weeks of treatment. Repeat X-ray chest also showed resolution of pneumopericardium.