This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Albrecht, C. A. Articles by Anderson, H. V. Search for Related Content PubMed PubMed Citation Articles by Albrecht, C. A. Articles by Anderson, H. V.

(Circulation. 2000;102:2792.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Cocaine-Induced Pneumopericardium

Carlos A. Albrecht, MD; Abbas Jafri, MD; Lisa Linville, MD; H. Vernon Anderson, MD

From the Division of Cardiology (C.A.A., H.V.A.) and the Department of Medicine (A.J., L.L.), University of Texas Health Sciences Center, Houston, Tex.

Correspondence to Carlos A. Albrecht, MD, Division of Cardiology, University of Texas Health Sciences Center, 6431 Fannin St, Suite 1.246, Houston TX, 77030. E-mail albrechtcarlos{at}hotmail.com

A20-year-old man without past medical history was admitted for diffuse left-sided and retrosternal chest pain after he was "told and forced to swallow crystal rocks." He denied any prior symptomatology and denied cough. In the emergency department, he had a normal physical examination and laboratory studies. The ECG, however, showed diffuse ST-segment elevations (Figure 1). He was admitted to the Coronary Care Unit. Within 6 hours of admission, he developed a pericardial friction rub. His urine toxicology screening was positive for cocaine. The chest x-ray was consistent with the diagnosis of pneumopericardium (Figure 2).

View larger version (36K): [in this window] [in a new window]   Figure 1. First ECG, which was taken on admission, shows diffuse ST-segment elevation across all leads. This pattern is consistent with acute pericarditis.

View larger version (155K): [in this window] [in a new window]   Figure 2. On admission, chest x-ray shows linear detachment along silhouette of left ventricle and left atrium (marked with arrows). At time of this x-ray, the patient had a loud pericardial rub.

On the second hospital day, the patient underwent both an esophageal contrast study with gastrografin and a cardiac echocardiogram. Both were normal. Subsequent chest x-rays showed a slow resolution of his pneumopericardium (Figures 3 and 4).

View larger version (83K): [in this window] [in a new window]   Figure 3. This ECG, which was performed on fourth hospital day, shows ST-segment elevation with improvement in bipolar leads and is consistent with clinical resolution of pneumopericardium.

View larger version (118K): [in this window] [in a new window]   Figure 4. On discharge, x-rays showed improvement of detached pericardium and, on auscultation, the pericardial rub could no longer be heard. Arrows indicate silhouette of left ventricle and left atrium.

Cocaine-induced pneumopericardium has seldom been reported, and its mechanism remains elusive. In the present case, we postulate that the likely use of "crack" cocaine with solid contaminants in the crystalline mass could have caused a microscopic esophageal tear and eventually produced a leak of air into the pericardial sac that was self-contained. The patient was discharged in stable condition on the fourth hospital day.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Albrecht, C. A. Articles by Anderson, H. V. Search for Related Content PubMed PubMed Citation Articles by Albrecht, C. A. Articles by Anderson, H. V.