A 52-year-old man presented to our hospital with chest pain and shortness of breath. He was being treated with chemotherapy for a peri- hilar, infiltrative squamous cell carcinoma of the left lung with nodal involvement. The chest radiograph revealed air outlining the inner surface of the mediastinal pleura, particularly around the aorta and the main pulmonary artery, consistent with pneumomediastinum. A computed tomograph) confirmed the pneumopericardium diagnosis, associated with a sizeable broncho-pericardial fistula created by the necrotic tumour.

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