A 16-year-old boy presented with sudden-onset chest pain. Six months prior to admission, he had undergone surgery for a mediastinal teratoma, and a small part of the teratoma's adherent pericardium had been resected without suturing. His vital signs were unremarkable. A physical examination revealed diminished right-side breath sounds and Hamman's sign (1). Distinctive ausculations called “Bruit de Moulin (mill-wheel murmur)” (2), which are resonant heart sounds with a tinkling superimposed over a succession splash, were also detected. Chest radiography (Picture 1) revealed right-side pneumothorax (white arrows) and pneumopericardium (black arrows), and chest computed tomography (Picture 2) additionally revealed pneumomediastinum (dotted arrow). The patient underwent three-port video-assisted thoracoscopic surgery (VATS). Two small bullae, including one ruptured bulla in the apical segment of the right upper lobe, and a pericardial deficit on the upper pulmonary hilum were observed (Picture 3). Bullectomy and pleural covering with a polyglycolic acid sheet were performed. Based on these findings, he was diagnosed with pericardial-mediastinal emphysema due to pericardial fistula-associated pneumothorax. His symptoms resolved with recovery from pneumothorax, and he was discharged home on postoperative day 13.
Picture 1.
Picture 2.
Picture 3.
The authors state that they have no Conflict of Interest (COI).
References
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