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Image of the Month—Quiz Case FREE

Piotr Gabryel, MD; Łukasz Gąsiorowski, MD, PhD; Bartłomiej Gałęcki, MD; Wojciech Dyszkiewicz, MD, PhD
[+] Author Affiliations

Author Affiliation: Department of Thoracic Surgery, Poznań University of Medical Sciences, Poland.


JAMA Surg. 2013;148(2):205. doi:10.1001/jamasurgery.2013.418a 10.1001/jamasurgery.2013.418b.
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A 63-year-old woman who had a left hemicolectomy 3 years ago (secondary to adenocarcinoma of splenic curvature of colon [T4N1, Dukes C2]) presented with dyspnea, retrosternal pain, and low-grade fever for a few days. A physical examination revealed tachycardia and hypotension. Auscultatory percussion over the heart was tympanic, and metallic splashing sounds synchronous with heart beats could be heard as well. A chest radiograph showed an area of radiolucency on both sides of the heart and a poorly visible, narrow radiolucent area extending toward the colon (Figure 1).

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Figure 1. Chest radiograph showing air in the pericardial cavity of a 63-year-old woman.

WHAT IS THE DIAGNOSIS?

A.  Acute pericarditis

B.  Gastropericardial fistula

C.  Malignant pericardial effusion

D.  Diaphragmatic hernia

Figures

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Figure 1. Chest radiograph showing air in the pericardial cavity of a 63-year-old woman.

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