支气管心包瘘形成引起的心包积气是继发于坏死性肺炎的罕见并发症。由于不同的化脓性细菌感染,报告了几种此类病例。据报道,持续的瘘管沟通会导致张力性心包和血流动力学不稳定。需要紧急干预,如心包引流。一个41岁的男性病人,已知患有慢性肾病和糖尿病,出现急性呼吸道症状。一被录取,患者发热,需要通过鼻叉进行氧气支持。胸部X光显示右侧有纤维空洞改变,心脏轮廓周围有斑驳的空气阴影和连续的隔膜体征。对比增强计算机断层扫描(CECT)胸部显示出广泛的巩固区域,内部有坏死区域,形成一个薄壁空腔,包括右中瓣。此外,发现该腔与右心房心包腔的可疑连通,与最小的心包收集和空气病灶内。胸水培养显示肺炎克雷伯菌生长。根据抗生素敏感性报告,患者开始静脉注射美罗培南和庆大霉素治疗21天,同时监测肾功能.患者在抗生素方面的临床改善,随访放射学检查显示心包积气消退。在这个病人身上,心包积气轻度,并且没有证据表明存在张力性气包膜。因此,提供了抗生素的保守管理,成功的决议。不像这个案子,如果存在张力性心包气的证据,需要紧急减压干预,这些病例的预后会很差。此病例证明了对坏死性肺炎患者高度怀疑和早期诊断心包气的重要性。这些患者的及时治疗可以防止进一步危及生命的后遗症。
Pneumopericardium due to bronchopericardial fistula formation is a rare complication secondary to necrotizing pneumonia. Several such cases are reported due to different suppurative bacterial infections. Persistent fistulous communication has been reported to lead to tension pneumopericardium and hemodynamic instability, requiring urgent intervention such as pericardial drainage. A 41-year-old male patient, known to have chronic kidney disease and diabetes mellitus, presented with acute respiratory symptoms. Upon admission, the patient was febrile and required oxygen support via nasal prongs. A chest X-ray showed fibrocavitatory changes on the right side, with patchy air shadowing around the cardiac silhouette and a continuous diaphragm sign. A contrast-enhanced computed tomography (CECT) thorax revealed extensive areas of consolidation with necrotic areas within, forming a thin-walled cavity involving the right middle lobe. Also, suspicious communication of this cavity with the pericardial cavity along the right atrium was seen, with minimal pericardial collection and air foci within. The pleural fluid culture showed growth of Klebsiella pneumoniae. According to the antibiotic sensitivity report, the patient was started on IV meropenem and gentamicin for 21 days while monitoring kidney functions. The patient clinically improved on antibiotics, and follow-up radiological investigations showed resolution of pneumopericardium. In this patient, pneumopericardium was mild, and there was no evidence of tension pneumopericardium. Thus, conservative management with antibiotics was provided, with successful resolution. Unlike this case, if evidence of tension pneumopericardium had been present, emergency interventions for decompression would have been required, and these cases would have had a poor prognosis. This case demonstrates the importance of high suspicion and early diagnosis of pneumopericardium in patients with necrotizing pneumonia. Prompt treatment in these patients can prevent further life-threatening sequelae.