A five-day old girl presented with a pneumopericardium discovered fortuitously on a radiograph (Figure 1). She was born at term with a prenatal diagnosis of right-sided congenital diaphragmatic hernia (CDH) and required high frequency ventilation and inotrope/pressor therapy since birth. On day-6 the pneumopericardium increased and a pneumomediastinum was noted (Figure 2). The newborn remained stable without signs of cardiac tamponade. On day-7, the pneumopericardium/mediastinum resolved and a pneumoperitoneum appeared (Figure 3). The condition of the child improved at the same time and it was possible to gradually diminish ventilation pressures and discontinue inotrope/pressor therapy. No intestinal perforation was noted during surgery a few hours later.

Neonatal pneumopericardium is a rare condition in the neonate, usually caused by mechanical ventilation [1]. The only previously reported association of pneumopericardium with pneumomediastinum and pneumoperitoneum was in a 77-year-old patient who received artificial ventilation following blunt chest trauma [2]. We believe that the air in the pericardial space dissected into the thoracoabdominal peritoneal cavity leading to hemodynamic and respiratory improvement in this newborn with CDH.

This is the first case of a newborn with CDH presenting with pneumopericardium resulting in pneumoperitoneum and improvement of respiratory and hemodynamic functions before surgery.

Keywords: Congenital diaphragmatic hernia (CDH), Pneumopericardium, Pneumomediastinum

1. Jeng MJ, Lee YS, Tsao PC, Soong WJ. Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc 2012 Nov;75(11):551–9.   [CrossRef]   [Pubmed]    
2. Anderson O, Yaakub A, Sinha A. Pneumoperitoneum associated with pneumopericardium and pneumomediastinum following blunt chest trauma. Injury Extra 2007;38(12):439–41.   [CrossRef]