A rare complication of a thoracic wound: the pneumopericardium?

Pneumopericardium (PPC) is defined by the presence of gas in the pericardial cavity, often leading to cardiac tamponade and a high mortality rate. This report describes a case involving a 33-year-old man found deceased a few meters from a knife, his clothes intact, with no resuscitation attempt made. A knotted scarf was tightly fastened around his neck, without ligature mark. Post-mortem CT revealed 271 ml of gas in the pericardial cavity, with "flattened heart". The forensic examination revealed two thoracic stab wounds, one penetrated the pericardium without penetrating the heart chamber, while the second remained superficial. In the absence of resuscitation or exsanguination, and in the presence of some non-specific signs observed in the context of asphyxia, the hypothesis of death by compressive PPC was supported. This first French case report of PPC highlights the rarity of this entity in forensic settings, and comparison with other cases described in the literature which did not present the same characteristics points out the diagnostic difficulties it presents and the importance of post-mortem CT in diagnosis.