Fatal pneumopericardium in a road traffic accident: An uncommon contributor to death in the presence of traumatic brain injury

A pneumopericardium is a condition characterized by the presence of air or gas within the pericardial sac. Sixty percent of pneumopericardium in adults is caused by traumatic events, specifically penetrating chest trauma. Clinical monitoring is sufficient for patients with no hemodynamic instability while waiting for air absorption. In contrast, if pericardial tamponade develops, pericardiocentesis or immediate surgery to seal the channel between air and pericardium is required. However, whenever there are multiple injuries are present, the clinician's attention can divert to a more severe form of injury and may miss other injuries that can be potentially fatal. We present a rare case of isolated pneumopericardium without pneumothorax in a 48-year-old male who was involved in a road traffic accident. The condition developed gradually and was only identified during the postmortem. We provide a detailed account of the clinical presentation, hospital course, and macroscopic and microscopic autopsy features. This case report emphasizes the necessity of assessing all possible complications in polytrauma cases that have the potential to be fatal despite the fact that they were not identified during the initial evaluation.