Clinical Images

Iatrogenic Pneumopericardium During Pericardiocentesis

Sourabh Agstam, MBBS, MD, DM; Anunay Gupta, MBBS, MD, DM; Preeti Gupta, MBBS, MD, DNB; Tushar Agarwal, MBBS, MD

Sourabh Agstam, MBBS, MD, DM; Anunay Gupta, MBBS, MD, DM; Preeti Gupta, MBBS, MD, DNB; Tushar Agarwal, MBBS, MD

J INVASIVE CARDIOL 2020;32(11):E299. 

Key words: complication, pericardiocentesis, pneumopericardium


A 25-year-old woman was admitted with weight loss and progressive shortness of breath for 1 month. Her blood pressure was 90/60 mm Hg, pulse rate was 110 beats/minute, and pulsus paradoxus was present. Transthoracic echocardiography showed massive pericardial effusion with tamponade physiology. 

The patient was taken for fluoroscopy-guided pericardiocentesis. After local anesthesia, puncture was taken with an 18 Fr needle attached to a 10 ml syringe. Approximately 6-7 mL of fluid was aspirated. While removing the syringe from the needle hub for passage of the guidewire, the patient took a deep breath. This accidentally sucked air through the hub of the needle, leading to iatrogenic pneumopericardium (Figure 1; Video 1). The swinging movements of the heart in tamponade became evident (Video 2). We aspirated 1000-1500 mL of fluid, which was straw in color. There was no evidence of pneumopericardium after aspiration.

Iatrogenic pneumopericardium after pericardiocentesis due to accidental leakage from the side port of the sheath has been reported in the literature. In the present case, it occurred during passage of the guidewire. Every step needs to be done meticulously. The patient should be advised not to take a deep breath during the puncture.

View the Accompanying Video Series Here.


From the VMMC and Safdarjung Hospital, New Delhi, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 29, 2020.

Address for correspondence: Sourabh Agstam, MBBS, MD, DM, Assistant Professor in Cardiology, VMMC and Safdarjung Hospital, New Delhi, India. Email: sourabhagstam@gmail.com

/sites/invasivecardiology.com/files/articles/images/E299%20Agstam%20JIC%202020%20Nov%20wm.pdf