Pericardial Hematoma Research Articles

Postmortem contrast-enhanced computed tomography via direct large-vessel puncture

The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52–92) at the time of death. The mean time elapsed since death was 29.1 h (12.0–72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3–4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding.

Loculated pericardial hematoma diagnosed with point-of-care ultrasound

Loculated pericardial hematoma diagnosed with point-of-care ultrasound

Pericardial Hematoma Following Coronary Angiography

ntroduction: Pericardial hematoma is defined as an accumulation of blood in the pericardial space, located in close proximity to the myocardium and deep to the fibrous pericardial sac, which encloses the heart. Case Description: We present a rare case of pericardial hematoma following percutaneous coronary intervention in an individual presenting with stenotic vein graft following symptoms of a myocardial infarction. Initial computed tomography (CT) scan demonstrated hematoma in the pericardial space. This finding was managed conservatively and hematoma was deemed stable on serial CT scans. Discussion: In this urgent situation, CT imaging proves valuable due to its speed, convenience, and accuracy in visualizing the target area from different perspectives. Although patients may appear stable initially after a perforation, a pericardial hematoma can rapidly spread, leading to unstable blood flow that requires prompt intervention and long-term monitoring.

Loculated pericardial hematoma compressing the right atrium post mechanical aortic valve replacement and the role of point-of-care echocardiography: a case report

BackgroundBleeding in the postoperative period after cardiac surgery is relatively frequent, especially in patients with early anticoagulant therapy, as in the case of mechanical valve replacement. Diffuse hemopericardium is relatively easy to diagnose; however, loculated pericardial hematomas leading to hemodynamic collapse are relatively rare and their diagnosis is more challenging.Case presentationThis report is of a 75-year-old Asian woman who presented dyspnea, confusion and hemodynamic collapse related to loculated pericardial hematoma compressing the right atrium 3 days after mechanical aortic valve replacement. Urgent transthoracic echocardiogram performed as point-of-care approach showed right atrial compression, the aortic valve prosthesis had normal function. Surgical removal of the hematoma resulted in complete recovery.ConclusionLoculated pericardial hematoma might lead to hemodynamic collapse. Close monitoring of hemodynamic parameters is essential, also point-of-care echocardiography is essential for early recognition and prompt management in patients with critical hemodynamic condition.

Echocardiographic features of myocardial rupture after acute myocardial infarction on emergency echocardiography.

Myocardial rupture is a fatal complication of acute myocardial infarction (AMI). Early diagnosis of myocardial rupture is feasible when emergency physicians (EPs) perform emergency transthoracic echocardiography (TTE). The purpose of this study was to report the echocardiographic features of myocardial rupture on emergency TTE performed by EPs in the emergency department (ED). This was a retrospective and observational study involving consecutive adult patients presenting with AMI who underwent TTE performed by EPs in the ED of a single academic medical center from March 2008 to December 2019. Fifteen patients with myocardial rupture, including eight (53.3%) with free wall rupture (FWR), five (33.3%) with ventricular septal rupture (VSR), and two (13.3%) with FWR and VSR, were identified. Fourteen of the 15 patients (93.3%) were diagnosed on TTE performed by EPs. Diagnostic echocardiographic features were found in 100% of the patients with myocardial rupture, including pericardial effusion for FWR and a visible shunt on the interventricular septum for VSR. Additional echocardiographic features indicating myocardial rupture were thinning or aneurysmal dilatation in 10 patients (66.7%), undermined myocardium in six patients (40.0%), abnormal regional motions in six patients (40.0%), and pericardial hematoma in six patients (40.0%). Early diagnosis of myocardial rupture after AMI is possible using echocardiographic features on emergency TTE performed by EPs.

Preoperative pericardial hematoma in patients with acute type A aortic dissection (AAAD): Do we need an adjusted treatment?

ObjectiveAn acute type A aortic dissection (AAAD) is a critical emergency and remains one of the most challenging diseases in cardiothoracic surgery. The existence of a pericardial hematoma caused by an aortic rupture can dramatically reduce the chances of survival (Jerzewski and Kulik in J Card Surg 29(4):529–530, 2014; Mehta et al. in Circulation 105(2):200–206, 2002; Gilon et al. in Am J Cardiol 103(7):1029–1031, 2009; Isselbacher et al. in Circulation 90(5):2375–2378, 1994). We assessed the surgical outcome of a high-risk group of patients with AAAD and a pericardial hematoma.MethodsIn this study we included 430 Patients (67% male; median age: 64 years) who received surgical treatment between January 2000 and January 2018 at our facility for acute aortic dissection DeBakey type I. We divided the cohort in two groups: Group A consisted of high-risk patients with a pericardial hematoma (n = 162) and Group B of patients without pericardial hematoma (n = 268).ResultsPatients with a preoperative pericardial hematoma had a significantly higher requirement for preoperative mechanical resuscitation (A: 21%; B: 1.5%; P: < 0.001) and were relevantly more frequently admitted to the operation theater with an intubated status (A: 19.8%; B: 8.6%; P: < 0.001). The incidence of visceral malperfusion differed significantly between both groups (A. 11.7%, B. 6:0%; P: 0.034). Limited aortic arch repair (proximal aortic arch replacement) was preferred in the high-risk group (A: 51.9%; B: 40.3%; P: 0.020). However, survival time was generally reduced in these patients (A: 7.5 y; B: 9.9 y).ConclusionAAAD patients with preoperative pericardial hematoma present themselves in potentially lethal conditions, with a significantly higher rate of visceral malperfusion. Despite the existence of this risk factor, a limited arch repair was favored. We have proven that cardiac compression is associated with preoperative intubation and mechanical resuscitation. Patients with pericardial hematoma must be further evaluated for preoperative pericardial drainage. In the event of long transfer times to an aortic center a slow drainage should be discussed to prevent early mortality.

BRUGADA-LIKE ECG PATTERN AND TUMORS INVOLVING RIGHT VENTRICULAR OUTFLOW TRACT - CASE SERIES AND LITERATURE REVIEW.

Mechanical heart compression, including that from mediastinal tumor, may cause Brugada-like ECG pattern. Such ECG pattern might also be observed in intracardiac tumor obstructing the right ventricular out"ow tract (RVOT). Eight cases with Brugada-like ECG and tumors involving RVOT have been described so far; 4 growing in the mediastinum (with one example of in"ammatory mass), 3 with intracardiac location, and 1 being an organized pericardial hematoma. The authors present other 3 cases of intracardiac metastatic tumors in RVOT and Brugada-like ECG pattern with coved ST-segment elevation in the right precordial leads. All patients had negative history of cardiovascular disease or familiar malignant arrhythmia occurrence. ECG were done routinely; none of the patients had chest pain or an increased level of cardiac troponins. In all patients, neoplastic disease was at advanced stage. A 76-year-old male, had a history of four neoplasms: bladder cancer was being treated with chemotherapy, while prostate, tongue, and lung cancers had been resected years ago and no signs of local relapse were found. A 78-year-old female, was diagnosed with colon cancer 1 month after an episode of venous thromboembolism. Six months after the resection of cancer, second focus of adenocarcinoma was found in the rectum. Third patient, a 65-year-old-male had undergone nephrectomy for renal cancer a year before cardiac metastasis diagnosis.

Multiple pericardial hematomas: a case report and mini-review in multimodality imaging

BackgroundPericardial hematoma is blood accumulation in the pericardial space. Although rare, it could arise in various conditions, such as after cardiac surgery. Clinical diagnosis of pericardial hematoma is implausible; thus, cardiac imaging plays a pivotal role in identifying this condition. We presented a case of multiple pericardial hematomas, which was found as an incidental finding in post-cardiac surgery evaluation. We highlighted the diagnostic challenge and the key features of multi-modality cardiac imaging in pericardial hematoma evaluation.Case presentationAn asymptomatic, 35-years old male, who underwent surgical closure of secundum atrial septal defect (ASD) one month ago, came for routine transthoracic echocardiography evaluation. An intrapericardiac hematoma was visualized at the right ventricle (RV) 's free wall side. Another mass with an indistinct border was visualized near the right atrium (RA). This mass was suspected as pericardial hematoma differential diagnosed with intracardiac thrombus. Cardiac computed tomography (CT) scan showed both masses have an attenuation of 30–40 HU; however, the mass's border at the RA side was still not clearly delineated. Mild superior vena cava (SVC) compression and multiple mediastinal lymphadenopathies were also detected. These findings are not typical for pericardial hematomas nor intracardiac thrombus; hence another additional differential diagnosis of pericardial neoplasm was considered. We pursued further cardiac imaging modalities because the patient refused to undergo an open biopsy. Single-photon emission computer tomography (SPECT)/CT with Technetium-99 m (Tc-99 m) macro-aggregated albumin (MAA) and Sestamibi showed filling defect without increased radioactivity, thus exclude the intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) reveals intrapericardial masses with low intensity of T1 signal and heterogeneously high intensity on T2 signal weighted imaged and no evidence of gadolinium enhancement, which concluded the diagnosis as subacute pericardial hematomas. During follow-up, the patient remains asymptomatic, and after six months, the pericardial hematomas were resolved.ConclusionPericardial hematoma should be considered as a cause of pericardial masses after cardiac surgery. When imaging findings are atypical, further multi-modality cardiac imaging must be pursued to establish the diagnosis. Careful and meticulous follow-up should be considered for an asymptomatic patient with stable hemodynamic.

Coexistent left ventricular clot and self-contained pericardial haematoma: An unusual combination found in a patient post inferior ST-elevation myocardial infarction

The discovery of a left ventricular (LV) thrombus in combination with a pericardial haematoma is a rare occurrence secondary to a complicated myocardial infarction (MI). A 53-year-old male was brought to our emergency in an unresponsive state with unstable haemodynamics. Electrocardiogram showed inferior and right ventricular ST-elevation MI. The patient underwent primary percutaneous coronary intervention of the right coronary and right posterior descending arteries. Echocardiography revealed a mobile clot in the LV apex, secondary to subacute myocardial rupture, and a self-contained pericardial haematoma. Therapeutic subcutaneous enoxaparin was commenced for the LV clot. Changes in the size of the haematoma and LV clot were monitored through serial echocardiographies. The patient underwent an uneventful course where there was gradual dissolution of the clot and resolution of the haematoma. This case illustrates the clinical dilemma of administering anticoagulation for LV clot in the presence of a self-sealed haematoma that could have otherwise resulted in cardiac tamponade and LV wall rupture.

Prevalence and incidence of adverse events with catheter ablation for adults with Wolff-Parkinson-White syndrome: a systematic review protocol.

The objective of this review is to synthesize the best available evidence to determine the prevalence and incidence of adverse events in patients with Wolff-Parkinson-White syndrome who have undergone catheter ablation. Wolff-Parkinson-White syndrome is a rare congenital heart disease affecting the normal cardiac conduction system that predisposes an individual to tachyarrhythmias. Patients with Wolf-Parkinson-White syndrome can experience a wide range of life-threatening symptoms and frequently undergo catheter ablation procedures to treat this disease. These patients are at risk of developing a variety of adverse events, including pericardial effusion, cardiac tamponade, atrial fibrillation, stroke, cerebral hemorrhage, major bleeding or hematoma, deep vein thrombosis, atrioventricular-block, cardiac perforation, coronary artery injury, pulmonary emboli, and death. This review will include adults aged 18 or older with a diagnosis of Wolff-Parkinson-White syndrome who have undergone catheter ablation, including radiofrequency ablation and cryoablation. MEDLINE, CINAHL, Scopus, Embase, and Web of Science databases will be searched from 1980 to the present for English-language studies only. Prevalence and incidence data, experimental, quasi-experimental, observational, and descriptive studies will be included and critically appraised by two independent reviewers. Data will be extracted using the standardized data extraction tool for prevalence data. If sufficient data is available, a meta-analysis will be conducted; otherwise, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. PROSPERO CRD42020180391.

Re-exploration Early after Cardiac Surgery in Adults: The Importance of Bleeding-Related Complications.

Re-explorations soon after cardiac surgery are mostly related to bleeding or unclear hemodynamic situations possibly related to heart compression resulting from pericardial hematoma. This condition has a significant impact on mortality, morbidity, and costs. The aim of this study was to analyze indications and outcomes of re-exploration for bleeding or pericardial tamponade early after cardiac surgery in adults. The clinical data of 4790 consecutive adult patients who underwent cardiac surgery in our institution from January 2011 to May 2016 were retrospectively analyzed. We identified 331 re-explorations performed in 231 patients. Sixty-seven of these patients had >1 re- exploration. In most cases (88%), repeat sternotomy was performed. Most procedures (57%) were performed within the first 48 hours. In two-thirds of re-explorations, active bleeding or pericardial hematoma was verified. In the remaining cases, neither bleeding nor significant pericardial hematoma leading to tamponade was found. Among the cases with active bleeding causes, the most bleeding sites were found to be at the coronary anastomosis and the epicardial exposure harvesting site, as well as from the side branches of bypass grafts and intercostal arteries. The incidence of re-exploration after cardiac surgery in adults was low (4.8%). In about two-thirds of the cases, active bleeding or significant pericardial hematoma was found. The most common bleeding causes were the easiest to treat.

Therapeutic efficacy for traumatic asphyxia with a focus on cardiac arrest

To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies. Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases). All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients' injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered. In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.

328 Echocardiographic Features Aiding in Diagnosis of type A Dissection; Forgotten Acoustic Window and Indirect Features

Aortic dissection remains an important differential diagnosis in the patients with chest pain. Typically, echocardiographers focus on visualisation of an intimal flap from a parasternal window when a type A dissection is the suspected diagnosis and in some cases this window does not provide diagnostic features. In these cases, additional acoustics windows which demonstrate secondary features are crucial. For example, a 54-year-old man presented with sudden onset of chest pain, dizziness, dyspnoea and diaphoresis after a transient anopia on the background of hypertension, sickle cell trait and neurosurgical repair for spinal fluid leak. 1mm ST-elevation in anteroseptal leads without reciprocal changes and a minor troponin rise was identified. CT-PA excluded pulmonary embolism however indicated pericardial effusion. The first two echo studies demonstrated a pericardial effusion subcostally with the third revealing echocardiographic characteristics of hemopericardium with evidence of haemodynamic compromise, congruent with the clinical scenario of hypotension requiring fluid resuscitation. The finding of hemopericardium raised suspicion for aortic dissection or cardiac chamber perforation. CT aorta showed a penetrating ulcer within the proximal ascending aorta with mural thickening, extending from root to level of isthmus, representing a type A dissection. Successful conduit with coronary re-implantation, ascending aorta replacement and mechanical AVR were urgently pursued with desirable outcomes. In acute chest pain patients with high-risk features, the presence of pericardial haematoma should raise suspicion for acute aortic syndromes and prompt further investigation. This case highlights the importance of utilising all acoustic windows and the importance of identifying secondary features to aid in identification and intervention thus improving patient outcomes.

Traumatismo cardíaco penetrante en pediatría: presentación de caso, Hospital Infantil Dr. Robert Reid Cabral (HIRRC), República Dominicana

Introducción: el traumatismo cardíaco es una condición poco frecuente en edad pediátrica, ocurriendo en menos del 5 % de traumatismos torácicos. Afecta más frecuentemente los ventrículos que las aurículas. Según el mecanismo de injuria puede ser: cerrado (como las contusiones torácicas) o penetrante (como las heridas por arma blanca o armas de fuego).&#x0D; El siguiente documento tiene la intención de describir la presentación clínica y el manejo de un paciente pediátrico con traumatismo cardíaco penetrante; se pretendió realizar una revisión de literatura sobre otros casos de traumatismo cardíaco penetrante.&#x0D; Presentación del caso: se expone el caso clínico de un paciente masculino de 14 años de edad, quien es referido al centro por historia de herida de arma blanca en región precordial izquierda. Se recibe con inestabilidad hemodinámica y hemitórax izquierdo hipodinámico; luego de realizar estudios de imagen y laboratorio se decide realizar toracocentesis. Ante evidente deterioro clínico, se decide realizar exploración quirúrgica, donde se halla laceración del ventrículo izquierdo y hematoma pericárdico, y se procede a drenar hematoma y cardiorrafia de ventrículo izquierdo.&#x0D; Conclusión: luego de describir la presentación y manejo de nuestro paciente, llegamos a la conclusión de que la sospecha clínica y el diagnóstico y manejo precoz son imprescindibles para mejorar el pronóstico de estos traumatismos. Asimismo, entendemos pertinente la exploración quirúrgica temprana ante los casos de inestabilidad hemodinámica, evitando el retraso de un tratamiento oportuno.

Diagnostic Value of 64-Slice Multi Detector Computed Tomographic Angiography in Assessment of Complicated Coronary Artery Bypass Graft

AbstractBackground: Coronary Artery Bypass Grafting (CABG) is to replace occluded or stenosed coronary arteries with patent venous or arterial conduits. Long-term sequelae after CABG include native coronary artery disease progression and de novo arthrosclerosis in grafts, resulting in recurrent ischemic symptoms and mortality.Aim of Study: This study was undertaken to form the basis of review on the role of 64 Multi-Detector Computed Tom-ography (MDCT) in detecting possible complications in post coronary artery graft (CABG) patients.Material and Methods: During the period from November 2015 to August 2017, a prospective evaluation of 50 patients with suspected post-CABG complications underwent MDCT coronary angiography in radiology department of International Medical Center in Egypt. Informed consent was obtained from all patients and the study had institutional review board approval. Descriptive statistics were used to analyze the data.Results: There were 40 males and 10 females, their mean age ± (SD) of 59±3.9 years. A total of 129 grafts were available for evaluation. From the total 129 graft 25 grafts were occluded as 24 of them showing the occlusion at the proximal anasto-mosis and the remaining one at the distal anastomosis. 8 grafts showed significant stenosis. Two showing ulceration at anas-tomotic site and 6 showing kinking course while one was showing competitive flow distally and one showing retrograde felling. Four grafts show stent placement. From the total evaluated 50 patients four patients were underwent redu operation. One patient had partial thrombosis in left subclavian artery encroaching upon LIMA origin. Three patients were suffering from fever one had pneumonia and the other two had chest wall infection with retrosternal extension and associated mediastinal involvement. Four patients show sternal dehiscence. One patient showed localized pericardial hemato-ma. Sex patients showed ascending aortic aneurysm and two showed main pulmonary artery aneurysm. All these compli-cations occurred from 6 menthes to 13 years post CABG surgery.Conclusion: MDCT is an easy non-invasive technique which showed to be effective in diagnosis of post-operative CABG related and non-related complications and is very informitive in difficult clinical situations.

A case of effusive constrictive pericarditis-related disease with pericardial hematoma of unknown origin

A case of effusive constrictive pericarditis-related disease with pericardial hematoma of unknown origin

Multi-modality Imaging Assessment of Pericardial Masses.

This review will discuss the application of various imaging modalities including their advantages and disadvantages in the evaluation of the most common pericardial masses with a focus on pericardial cysts, tumors, and hematomas. Accurate identification of pericardial masses and assessment of potential hemodynamic compromise is imperative for management. Cardiac imaging plays a central role in tissue characterization as well as evaluation of extension into neighboring structures. Currently, echocardiography is the preferred modality for the initial evaluation due to its low cost and widespread availability. However, due to potential limitations with echocardiography, computed tomography (CT), and cardiac magnetic resonance (CMR) imaging have become robust complementary imaging tests. CT provides superior spatial resolution and is the ideal test for evaluation of calcified masses while CMR provides excellent tissue characterization through various CMR sequences. Finally, positron emission tomography (PET) imaging can provide additional unique information in the assessment of potentially malignant tumors. An integrated, multi-modality imaging approach is helpful to evaluate the pericardium and diagnose pericardial masses. Advancements in imaging technology have provided improved diagnostic accuracy, with CT and CMR currently serving as complementary imaging techniques to traditional echocardiography imaging. Because each imaging modality has its unique sets of advantages and disadvantages, the choice of modality must be individualized to each patient. Through careful consideration, an integrated imaging approach is crucial in noninvasively providing information on cardiac structure, morphology, function, and associated complications that are important to the diagnosis and management of a variety of pericardial masses.

Preklapanje akutne disekcije aorte sa uklještenjem diska torakalne i lumbosakralne kičme

In this study we presented a patient with a chest pain, pain in thoracic and lumbosacral spine, which we supposed that they are consequence of earlier diagnosed herniated disc in thoracic and lumbosacral spine, but they masked clinical picture of aortic dissection. Pain lasted a few days, but patient had dizziness too. At admission day, patient had unconsciousness 1 minute. At first, we suspected on exacerbation of arthritis in thoracic and lumbosacral spine and possible acute coronary syndrome. Exacerbation of herniated discs in lumbosacral spine was confirmed, acute coronary syndrome was excluded, and further evaluation confirmed diagnosis of aortic dissection De Backey type 1 with pericardial hematoma which was treated by surgery.

Left Atrial Compression Caused by an Intrapericardial Hematoma after Coronary Artery Bypass Graft Surgery

BackgroundLeft atrial compression (LAC) is an uncommon condition that causes left ventricular inflow obstruction. The clinical and pathologic features are similar to those of mitral stenosis. Impaired left ventricular filling may cause hypotension, syncope, or shock. The increased left atrial pressure causes retrograde increase of the pressure throughout the pulmonary circulation with subsequent signs of congestion. Case ReportAn 84-year-old man presented with LAC caused by a focal tamponade related to a pericardial hematoma as a complication of coronary artery bypass graft (CABG) surgery. The formation of the hematoma occurred 3 weeks postsurgery. The echocardiographic study before discharge at day 12 after CABG surgery showed neither a focal hematoma nor a tamponade. The diagnosis was made 6 days later. Why Should an Emergency Physician Be Aware of This?Intrapericardial tamponade caused by bleeding is a known complication of CABG surgery in the early postoperative stage. However, emergency physicians should be aware that a postoperative hematoma may also present as a focal tamponade because of postoperative adhesion by scar formation. The literature of LAC is limited. The most reported causes of LAC are compression caused by structures of the gastrointestinal tract, followed by thoracic aortic pathology. A Medline search for the terms “left atrial compression and hematoma” and “left atrial compression and intrapericardial hematoma” found only 31 and 4 hits, respectively. We also briefly discuss the import role of bedside echocardiography in the diagnostic process of LAC in the emergency medicine department.

A case of iatrogenic massive pericardial hematoma developing after diagnostic pericardiocentesis

A case of iatrogenic massive pericardial hematoma developing after diagnostic pericardiocentesis