We present 2 patients who developed tension pneumopericardium after undergoing unilateral lung transplantation, describing their clinical evolution after surgery until the diagnosis of tension pneumopericardium. In both cases aspiration of air from the pericardium resulted in improved hemodynamic status. Tension pneumopericardium is rare in adults. Our patients were at high risk due to the difficulty of ventilating native and implanted lungs with different compliances. Moreover, the passage of air from the mediastinum to the pericardium is facilitated by the large opening made in order to dissect the pulmonary veins.
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