An echocardiographic artifact gave us the diagnosis

Excerpt

A 55-year-old male who was a heavy smoker was admitted to the emergency department. He presented with a 1-month history of productive cough and pleuritic chest pain. A thorough study was performed, leading to the diagnosis of small-cell lung carcinoma with metastasic disease. Pericardial effusion was noted in a thorax computed tomography scan. A transthoracic echocardiogram confirmed the presence of pericardial effusion with diastolic collapse of the right ventricle and both atria as signs of cardiac tamponade. The patient underwent pericardiocentesis and 600 ml of serohematic fluid was obtained. Pericardial drainage was removed after 3 days, and the patient remained asymptomatic. A second echocardiogram was then performed, but the two-dimensional acquisitions could not be properly assessed due to an imaging artifact. The subcostal view showed spontaneous pericardial echoes and the M-mode indicated that these were related to the cardiac cycle (Fig. 1a, b). These findings suggested the presence of air within the pericardial sac, a condition known as pneumopericardium. This diagnosis was later confirmed on chest radiography, which revealed the presence of the “halo sign” (Fig. 1c). Since the patient was asymptomatic, a conservative approach was taken: radiographic control after 1 week showed pneumopericardium resolution (Fig. 1d).

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