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A Heart in the Air

Figure 1. The chest radiograph revealed a pneumopericardium without signs of concomitant pericardial effusion. A 60-year-old male with a history of advanced esophageal cancer was admitted due to progressive dyspnea and shock. The chest radiography showed a heart surrounded by a radiolucent area (Figure 1). Emergent pericardiocentesis was suggested but refused by his family, and the patient died of refractory shock. Pneumopericardium is a rare clinical entity generally associated with chest trauma. In our case, the most probable cause was a fistulous communication between the esophagus and the pericardial sac related to the cancer.