Pneumopericardium, pneumothorax, and pulmonary hemorrhage from invasive pulmonary aspergillosis. A case report

Pneumopericardium is a rare condition with etiologies including adjacent infection, pathology, or trauma. Invasive pulmonary aspergillosis occurs almost exclusively in immunocompromised patients and may be associated with pneumopericardium. We present a 12-year-old female with acute lymphoblastic leukemia who developed multifocal pulmonary Aspergillus terreus after induction chemotherapy and prolonged granulocytopenia. Despite aggressive antifungal therapy, she developed pneumopericardium, which progressed to pneumothorax and pulmonary hemorrhage, resulting in death. To our knowledge, no reports involving the sequential development of these three findings are reported to date. Unusual to her case was the development of pneumopericardium without fistula or direct evidence of Aspergillus pericarditis.