Image| Volume 18, ISSUE 5, P361-362, October 2009

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      We present a case of a 43-year-old woman with a history of chronic idiopathic pericardial effusion, which has been diagnosed 6 years ago. The patient reported an increasing dyspnea over the last 2 months. Echocardiographic examination showed a massive pericardial effusion with compromise of the right atrium and ventricle, and an increase in the respiratory variation of mitral valve inflow velocities, suggested of haemodynamic compromise. A therapeutic pericardiocentesis was performed using a subxyphoidal approach. Five hundred millilitres of serous fluid were drained and a marked reduction of the effusion was achieved. On day 1 after the pericardiocentesis, the patient developed a left sided chest pain. The chest radiography showed a new lucent outline around the heart representing the existence of air in the pericardial space (Fig. 1).
      Figure thumbnail gr1
      Fig. 1Chest radiography showed an abnormal shadow under the pericardium suggesting a band of gas surrounding the cardiac silhouette.
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