Woman With Chest Pain and Dyspnea

Abstract

A 48-year-old woman presented to the emergency department with 1 day of chest discomfort, dyspnea, and orthopnea. She was discharged from the hospital 2 days ago after radiofrequency catheter ablation for atrial flutter. Her ECG and chest radiography were both normal. Bedside cardiac point-of-care ultrasound showed a large hyperechoic mass in the left atrium (Figure 1, Figure 2, Videos E1 and E2).Figure 2Ultrasonographic apical view demonstrated the hyperechoic mass (arrowhead) occupying most of the left atrial cavity.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Left atrial intramural hematoma post–catheter ablation. Cardiac computed tomography (CT) demonstrated a left atrial intramural hematoma causing compression of the left ventricular inflow tract with a small pericardial effusion (Figure 3). The patient was admitted to the coronary care unit for monitoring and observation; at 4 days, her repeat cardiac CT demonstrated a stable hematoma, and she was discharged after 7 days. At 1 month, her cardiac CT later showed nearly complete resolution. The overall incidence of ablation-related complications has been decreasing over the last few decades as institutions have gained experience and is estimated at 3% although the incidence of left intramural hematoma is far lower.1Gupta A. Perera T. Ganesan A. et al.Complications of catheter ablation of atrial fibrillation: a systematic review.Circ Arrhythm Electrophysiol. 2013; 6: 1082-1088Crossref PubMed Scopus (188) Google Scholar, 2Giudicatti L. King B. Lee F. et al.Left atrial intramural hematoma post-ablation of supraventricular tachycardia: a rare complication treated successfully.JACC Case Rep. 2020; 2: 223-226Crossref PubMed Scopus (2) Google Scholar, 3Haseeb S. Kutyifa V. Left atrial intramural hematoma after radiofrequency catheter ablation: beware of the unexpected.JACC Case Rep. 2020; 2: 227-229Crossref PubMed Scopus (2) Google Scholar Bedside ultrasound is an excellent method to ascertain cardiac and pericardial complications. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxMGNkZTUyZjdjMGJhYWUzMjQ5MGM5NGJjYTYzYjBhNyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc1NzYwNTA0fQ.O-IwG7CyTItrbzjRokj7gIU1Hzxu7dNLt3ApgNoAp9vDpBMfLbEKgpWSk8sYHetH5Vz8WHXqbQ2Cb5ss4AUxggfsnbvgk0JbJyfkCH7qyJs_mP-wTCLwzS1Q24JLTBWQzQVzmb3YjKPAXSYRppC7irO7R1G0L9eWvgTh4CYPzGjHjYnv2SZGDAMs0B5-rwKF39aZX7nFRt2qVGQ1gzziYuZU7BY5WSC-bAXoQgWYkdsxh3rEwPY1IN8h_8YHSsy0G96mAfUj-9g-tlRjDXkNzYSbSTYYk63S5RN2LKLDaPROMI3LmTc3921xvygReltJLzubF18dMY8W8ZXs1VoEEw Download .mp4 (2.58 MB) Help with .mp4 files LAIH video clip ApicaleyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJlMTg0MjJlMWFjNTVlOTkzNWI1ZmI5NGZlOGY4ZGY0MSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc1NzYwNTA0fQ.EB2L0u__X22_jVC7TfUdeOdBiJ54hHMfy-4yLe29r_pmQiuv9u1aPe0vPHZuU6Gta7yZtdjWEv4vM4DVkRUyRfUihNIJp6x7yAEW-u4KvyI_2cHb3rxHPVvJkUmR4OQZepK8wffdyCytPuZoN79dpyFd2u_Clbq5jd5vI-nHfRJjhn4zM5IMBDQvyFUV76g4F1kw3qsR4hxw5sRff8b2xHM8b4MYHfXYg4AGLO8UsxEmtzVLk0EuiZiQKhRcu3UfvK0DzSas9uhkqp1W1COQY-JQOUk3ToqQMMRQZSDR5W9Orz9-lVB4P_CTTeBgyVXSwVAD8wUaYCq3tXqOU9EdTA Download .mp4 (2.87 MB) Help with .mp4 files LAIH video clip PLAX