Background: Pneumopericardium is the presence of air within the pericardial cavity. We report a case of iatrogenic pneumopericardium following pericardiocentesis in a patient with primary cardiac angiosarcoma. Additionally, we provide a systematic review of pericardiocentesis-associated pneumopericardium to offer a comprehensive overview and evaluate the role of echocardiography in its diagnosis. Methods: The PubMed database was searched from inception until January 2025 to perform a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate articles on iatrogenic pneumopericardium following pericardiocentesis published in the English language. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was used to appraise the included case reports. Results: Of the 108 search results obtained, after screening and a backward citation search, 37 articles were selected for inclusion in this review, accounting for a total of 37 patients. According to the JBI Critical Appraisal Checklist for Case Reports, 7 case reports were of high quality and 12 of low quality. The overall evidence of quality of the case reports was moderate, and 51.6% of patients developed hemodynamic compromise or showed signs of cardiac tamponade. The main underlying cause for the development of pneumopericardium was issues relating to the catheter drainage system; 64.9% of cases required decompressive therapy. Conclusions: Pneumopericardium can occur as a complication after pericardiocentesis and must therefore be considered in symptomatic patients. While detection by transthoracic echocardiography is difficult and relies on non-validated signs, chest X-ray and computed tomography can provide a definitive diagnosis.

Background and Clinical Significance: Left ventricular thrombus formation after acute coronary syndrome represents a severe complication. Comprehensive echocardiographic assessment of the entire ventricle is essential, as regional wall motion abnormalities predispose to thrombus development. Although vitamin K antagonists have traditionally been the cornerstone of therapy, the convenience of direct oral anticoagulants has made them increasingly popular. However, the paucity of prospective data raises concerns regarding their general interchangeability. Case Presentation: We present a case of a basal left ventricular thrombus that rapidly progressed in size despite triple antithrombotic therapy including Apixaban. Conclusions: Following ACS, regional LV dysfunction predisposes to LVT formation—even in patients with only mild to moderate systolic impairment or non-apical akinesia. Although rare, LVT may also develop in basal and mid-ventricular segments. Anticoagulant selection should remain individualized, and short-term follow-up imaging is necessary to monitor therapeutic response.