Three in One: Pneumopericardium, Pneumomediastinum, and Pneumothorax in an X-ray

We report the case of a term neonate (39+2 weeks' gestation) who developed concurrent pneumothorax, pneumomediastinum, and pneumopericardium, diagnosed incidentally during investigation of persistent tachypnoea.The infant was born by category 2 caesarean section in the context of prolonged rupture of membranes and maternal intrapartum pyrexia, and required brief positive end-expiratory pressure support for transient respiratory distress shortly after birth.A chest radiograph obtained on day 4 of life, performed to investigate the ongoing tachypnoea, unexpectedly revealed pneumomediastinum, a left anterior pneumothorax, and pneumopericardium.All three air leaks were managed conservatively with close clinical and cardiorespiratory monitoring and serial imaging; no invasive intervention was required.Pneumothorax and pneumopericardium resolved by day 6 of life, and the pneumomediastinum had resolved by outpatient review on day 12, with no ongoing concerns.This case highlights that multi-compartment air leak syndrome can present with subtle, nonspecific signs such as persistent tachypnoea rather than acute decompensation, and underscores the value of a low threshold for chest radiography in neonates with unexplained respiratory findings, even when initial concern centres on sepsis.