冠動脈造影時の咳嗽により誘発された特発性心嚢気腫

Idiopathic pneumopericardium caused by coughing during coronary angiography

　心嚢内に気体の存在する状態を心嚢気腫と呼ぶが，この中には，明らかな基礎疾患はなく発生し，きわめて予後が良好であるなど，いくつかの特徴を持ったものがあり，一般に特発性心嚢気腫と称きれている。今回，我々は，冠動脈造影時に強制的に行わせる咳嗽により誘発された特発性心嚢気腫の症例を経験したので文献的考察を加えて報告する。

The presence of gas in the pericardium is called pneumopericardium. In some cases, generally referred to as idiopathic pneumopericardium, it occurs without any clear underlying disease and is benign. We report here a case of idiopathic pneumopericardium induced by coughing during coronary angiography.

The patient was a 31-year-old male whose main complaint was chest pain. Left anterior chest pain appeared occationally without any clear cause, and gradually became more frequent. The patient was hos-pitalized for detailed examination of the chest pain, but no particularly abnormal findings were detected on the electrocardiogram, chest roentgenogram or in the physical findings. No lesions of coronary arteries were detected by coronary angiography. However, at x-ray fluoroscopy an image revealing air moving in the pericardium with the heart beat appeared imme-diately after forced coughing during the coronary ang-iography. At this time, the patient complained of left anterior chest pain. On the frontal chest roentgenogram in the right prone position, air was detected in the pericardium. The heart sound was a coarse high car-diac souffle in the systolic phase. These sounds were thought to be the so-called Hamman's symptoms aud-ible in the pericardium. After a 2-day rest, no air was detected in the pericardium on the roentgenogram.

The characterictics of idiopathic pneumopericardium are: 1) It often occurs in males in their teens, pro-bably because they have the opportunity to perform strong Valsalva maneuvers. 2) Some Valsalva maneu-vers or episodes that elevate the inner thoracic pre-ssure cause idiopathic pneumopericardium. 3) The prognosis is extremely good, and remission is seen after a few to 10 days of rest alone; however, such remission occurs only when the cause of the elevation of inner thoracic pressure is temporary.