A 49‐year‐old man was admitted to the intensive care unit after bilateral lung transplantation for hystiocytosis‐X. He developed acute respiratory distress syndrome, secondary to Pseudomonas aeruginosa and Candida albicans pneumonia, and required continuous positive pressure ventilation. On day 21, atrial fibrillation with haemodynamic instability occurred. A chest radiograph (see panel) showed a large aeric outline surrounding the cardiac silhouette. A chest computed tomographic (CT) scan confirmed the diagnosis of isolated pneumopericardium. Bronchoscopy revealed a 2 cm necrosis of the left bronchial sutures, and the patient underwent emergency surgery. No patent opening into the pericardial sac was found and microbiological samples of the pericardiac liquid remained sterile. Pneumopericardium is a very rare complication of lung transplantation, which usually occurs in the context of pulmonary infections, suture necrosis or during mechanical ventilation with high airway pressure; all these conditions were found in the present case.
