Conclusion:
The findings in the pericardium (pericardial effusion and pericardial thickening) could reflect an inflammatory process either sterile or infectious; In this case, pericardiocentesis was positive for pneumococcal infectious.
Mildly FDG avid mediastinal and bilateral hilar lymph nodes are likely reactive to the ongoing infectious process in the pericardium.
HISTORY and clinical course :
A 50-year-old male was admitted as a case of pleural and pericardial effusion. A whole-body PET scan was performed to assess infective endocarditis. He was found to have pyo-pericardium, pneumopericardium, and septic arthritis. The patient had disseminated pneumococcal infection, improving clinically with pericardial drainage, joint drainage, and Penicillin G.
Differential diagnosis of pneumo-pericardium:
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positive pressure ventilation
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thoracic surgery/pericardial fluid drainage
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penetrating trauma
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blunt trauma (rare)
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infectious pericarditis with gas-producing organisms
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Fistula between the pericardium and an adjacent air-containing organ (i.e. stomach or esophagus)