Pericardial Hematoma Research Articles

A voluminous and organized pericardial hematoma after open-heart surgery

A voluminous and organized pericardial hematoma after open-heart surgery

Pericardial Effusion With Beginning Cardiac Tamponade Caused by a Spontaneous Coronary Artery Rupture

A 65-year-old man was admitted to his local hospital with troponin-positive acute coronary syndrome. The patient developed signs of acute heart failure and was immediately transferred to our center. Echocardiography demonstrated a pericardial mass (8×5 cm) with compression of the right atrium (Figure 1 and online-only Data Supplement Movie I) and a reduced contractility of the posterior left ventricular wall. Magnetic resonance imaging demonstrated a pericardial hematoma that was incompressible, not vascularized, and impinging on the right atrium (Figure 2 and online-only Data Supplement Movie II). Figure 1. Echocardiographic 4-chamber view with …

Loculated Pericardial Hematoma Complicating Complex Coronary Interventions

An 86-year-old woman was admitted for elective percutaneous recanalization of a chronic total occlusion of the right coronary artery (Figure, panel 1), already documented in 1999. The occlusion was reopened successfully with a dedicated guidewire (Confianza, ASAHI INTECC, Ltd) and stabilized with implantation of 2 overlapping sirolimus-eluting stents (Figure, panel 2). No contrast staining was observed at the end of the procedure. After 2 hours, the patient developed intense prolonged and continuous chest …

Rib Perforation From a Right Ventricular Pacemaker Lead

A 50-year-old man was admitted to a community hospital for high fever. Seven years earlier, he had been in a motor vehicle accident and a cervical spine injury had resulted in quadriplegia and ventilator dependence. During that hospitalization, he was noted to have long sinus pauses that were thought to be vagally mediated, and a single-chamber pacemaker was implanted to hasten his recovery, with an active fixation pacing lead placed at the right ventricular apex (Figure 1A through 1C). His bradycardia spells subsequently disappeared, and minimal pacing was needed. Figure 1. Serial chest radiographs showing the pacemaker lead position at the time of implantation (A), at initial hospital discharge (B), 7 months after implantation (C), and at the current admission (D). The position of the lead tip is designated by an arrow, and the lead tip is clearly located outside the rib cage (D). Because of spiking fevers, leukocytosis, and methicillin-resistent Staphylococcus aureus growing from blood cultures; a …

Idiopathic Chronic Constrictive Pericarditis Secondary to Calcified Pericardial Haematoma

Pericardial haematoma is a rare entity that is thought to arise acutely as a consequence of blunt chest wall injury. We report our experience with a chronic form of presentation in which calcified pericardial haematoma presented as a mass causing chronic constrictive pericarditis symptoms in a patient with no prior history of chest wall injury. The ability to recognize such a rare occurrence is vital as surgery will often be curative.

Cardiac Tamponade Caused by Acute Spontaneous Coronary Artery Rupture

Acute spontaneous coronary artery rupture is rare and the diagnosis might be missed due to high risk of mors subita. We present three patients hospitalized with signs of cardiac tamponade due to acute spontaneous coronary artery rupture. All the three were successfully operated with evacuation of the pericardial hematoma, identification of the bleeding site, and hemostasis. The patients were examined with coronary angiography and computer tomography, and no underlying cause of the rupture was detected. In patients presenting with cardiac tamponade, acute spontaneous coronary artery rupture is a possible diagnosis.

A Case of Posterior Loculated Tamponade Masquerading as an Atrial Mass on Transesophageal Echocardiography

Localized cardiac tamponade has been known to appear in a variety of ways on imaging studies. A loculated pericardial hematoma leading to localized tamponade may appear on imaging studies as a cardiac mass. The differential diagnosis of this mass as extracavitary, intramural, or intracavitary disease on imaging studies is usually challenging and difficult. Imaging studies such as echocardiography and computed tomography can frequently lead to misdiagnosis of these loculated pericardial hematomas as intracardiac masses, leading to unnecessary surgical procedures. 1 Although transesophageal echocardiography (TEE) has been used as a procedure of choice in the diagnosis of pericardial and intracardiac disease, especially of a posterior location, we present the case of a 72-year-old man who underwent thoracotomy for an apparent large intracardiac mass on echocardiography, which turned out to represent a loculated pericardial hematoma posterior to the left atrium (LA), causing loculated tamponade, which had almost completely compressed the LA from behind, simulating a left atrial mass. The role of echocardiographic imaging interpretation in relation to the clinical setting is emphasized and discussed.

Localized Pericardial Hematoma Presenting With Acute Hypoxemia

Localized pericardial hematomas after cardiac surgery may have atypical clinical presentations due to regional alterations in cardiac function and hemodynamics. We report a case of extravascular thrombus that compressed the main pulmonary artery and produced acute hypoxemia due to right-to-left shunting across a patent foramen ovale. We review the pathophysiology leading to this finding and the echocardiographic studies that established the diagnosis.

Computed Tomography and Magnetic Resonance Imaging of the Pericardium: Anatomy and Pathology

The purpose of this article is to review the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of the pericardium and pericardial diseases. Because patients with pericardial diseases usually present with nonspecific symptoms, these diseases may not be detected until they have reached an advanced stage. It is therefore important to distinguish between normal pericardial structure and disease. Multiplanar reconstruction images of CT and MRI are useful for evaluating faint changes of the pericardium. The specific pericardial diseases described in this article include pericardial cyst, constrictive pericarditis, pericarditis with radiation pericarditis, postoperative pericardial hematoma, and cardiac tamponade due to a paracardiac mass (lymphoma).

Left Atrial Compression by a Pericardial Hematoma Presenting as an Obstructing Intracavitary Mass: A Difficult Differential Diagnosis

Left Atrial Compression by a Pericardial Hematoma Presenting as an Obstructing Intracavitary Mass: A Difficult Differential Diagnosis

A case of coronary artery fistula draining into the pericardium causing hematoma

A 28-yr old female patient admitted to our clinic because of dyspnea and chest pain. Her transesophageal echocardiography demonstrated a huge mass on the anterolateral wall of the left ventricle causing dysfunction of the myocardium. Coronary angiography demonstrated left anterior descending artery fistula draining into the pericardial cystic mass. Hydatic cyst was suspected and ELISA and hemagglutinin tests were both negative for Echinococcus granulosus. Magnetic resonance image of the heart showed a mass thought to be a hematoma inside the cyst. She underwent surgery. The cystic lesion with a pure hematoma inside, was excised, and the fistula between left anterior descending artery and the mass was ligated without any complications. To our knowledge, this is the first case of a pericardial hematoma due to a coronary artery fistula, in the English literature.

Fatal traumatic rupture of an aortic aneurysm of the sinus of Valsalva: an autopsy case

This report describes an autopsy case of a rare type of aortic sinus of Valsalva aneurysm, which caused fatal rupture from a blunt chest impact. A 51-year-old male was hit in the chest with a fist, lost consciousness after about 15 min and died after approximately 7 h. The postmortem examination revealed a large saccular aneurysm of the right coronary sinus bulging on the right atrium, which had a full laceration causing pericardial hematoma (cardiac tamponade). A related chest wall injury was observed in the right outer mammary region. A rare type of bulging onto the right atrium and subsequent sclerosis of the right coronary artery appeared to have greatly contributed to the fatal rupture.

Percutaneous Transmyocardial Intracardiac Retroperfusion Shunts: Technical Feasibility in a Canine Model

To test the technical feasibility of creating a left ventricle to coronary sinus shunt using endovascular techniques. By means of a right jugular vein approach, a needle puncture was made from the coronary sinus to the left ventricle in 10 dogs. The tracts were balloon dilated and lined with 6-mm Wallstents. Shunt patencies, immediate and 4-hours later, were fluoroscopically assessed by contrast material injection into the left ventricle. Blood pressure, pulse, oxygen saturation, and cardiac rhythm were monitored. The dogs were then euthanized. Thoracic cavities and hearts were dissected and inspected. Technical success and immediate shunt patency were 100%. No cardiac dysrhythmias, electrocardiographic changes, or reduction in voltage potential were seen. Eight (80%) of the shunts were patent at 4 hours, one (10%) had thrombosed, and one dog died. Nine (90%) dogs had no pericardial hematoma and one (10%) had minimal pericardial blood from needle passes into the pericardial sac. The coronary sinuses were intact and no injuries to the valve leaflets or chordae tendineae were seen. The puncture sites were from the coronary sinus, 1-2 mm (mean, 1.3) from its auricular orifice, into the left ventricle, just below the inferior margin of the posterior leaflet of the mitral valve. One dog died at 3 hours with no preceding electrocardiographic evidence of impending demise. Autopsy showed no pericardial hematoma and the heart findings were no different from the other nine dogs. Creation of a left ventricle to coronary sinus shunt with use of endovascular techniques is technically feasible. Study of a transmyocardial intracardiac coronary retroperfusion shunt to deliver oxygenated blood to the ischemic myocardium is warranted.

Mitral regurgitation late after manouguian's anulus enlargement and aortic valve replacement

J Thorac Cardiovasc Surg 1998;115:727-9

Characterization and surgical resection of an organized pericardial hematoma assisted by transesophageal echocardiography

We describe the echocardiographic features of a rare pericardial hematoma causing elevated venous pressure in a patient who had suffered blunt chest trauma in the past. Transesophageal echocardiography demonstrated a large, partially calcified mass in the right cardiophrenic angle impinging on the tricuspid annulus and facilitated intraoperative assessment of surgical resection.

Recanalization of chronic coronary occlusions using a laser wire.

Between August, 1993-December, 1994, recanalization of a chronically occluded coronary artery was attempted in 412 patients, with an overall success rate of 77%. The main reason for failure was subintimal tracking of the guide wire. However, in 13 patients, advancing the guide wire was not possible either subintimally or in the former true lumen. In 8 of these 13 patients with failed conventional recanalization, a second attempt was made using a 0.018" laser wire. The suspected occlusion duration was 6 wk-6 yr, and the occlusion length 6-21 mm. Successful crossing of the occlusion was achieved in 7 of 8 patients. One patient experienced pericardial hematoma without severe clinical consequences. Adjunctive conventional laser angioplasty and/or balloon dilatation led to a residual stenosis of < 50% in 7 patients. The laser wire technique may become an important new method for recanalizing chronic total coronary occlusions in selected patients.

MRI postoperative monitoring in patients surgically treated for aortic dissection

In most cases, surgery of aortic dissections repairs only the ascending portion of the aorta, leaving a residual dissection in the arch and descending aorta. We studied 17 patients operated upon for type A aortic dissection. A total of 42 magnetic resonance imaging (MRI) examinations were performed, with two to five studies per patient (mean 2.47). The studies were done between 5 weeks and 47 months (mean 17.5 months) after surgery. The patients were evaluated by MRI using gated spin-echo and gradient-echo sequences on axial and oblique sagittal views, and in selected cases, coronal views. A high incidence of abnormalities was observed. Pericardial hematoma was observed in 11% of cases, aortic and branch involvement in 41%, abdominal aortic branch involvement in 47%, dilatation of native aorta in 58%, and extension of dissection in 10%. New complications were detected during follow-up in 53% of patients. MRI was helpful in the follow-up of patients operated upon for aortic dissections, owing to its noninvasiveness and multiplanarity. By means of this technique, it was possible to obtain information about the natural history of the disease, as well as information useful for subsequent treatment.

Transesophageal echocardiography in pericardial disease and tamponade.

While most pericardial disorders can be imaged by transthoracic echocardiography, transesophageal echocardiography may be required in those cases where pericardial pathology is clinically suspected, but cannot be imaged adequately with transthoracic echocardiography. Transesophageal echocardiography is especially helpful in patients after heart or chest surgery, with cardiac compression by a loculated pericardial hematoma, in patients with dissection, endocarditis, or interatrial shunting associated with pericardial effusion, in patients with pericardial tumors, and in the differential diagnosis between constrictive pericarditis and restrictive cardiomyopathy.

Inadvertent administration of rtPA to a patient with type 1 aortic dissection and subsequent cardiac tamponade

Administration of thrombolytic agents to patients with misdiagnosis of acute myocardial infarction can result in serious side effects. A case of aortic dissection that was misdiagnosed as acute myocardial infarction and received rtPA is reported. Within 1 hour of rtPA infusion, the patient developed cardiac tamponade. Type 1 aortic dissection was diagnosed by aortic angiogram. The patient underwent emergency resection of the dissection and evacuation of the pericardial and anterior mediastinal hematoma. Although he required massive transfusion of blood products intraoperatively, he is doing well 22 months after his surgery.

Usefulness of Transesophageal Echocardiography in Patients With Hemodynamic Deterioration Late After Cardiac Surgery

Two patients with large pericardial thrombi following cardiac surgery presented as having right cardiac tamponade. Transesophageal echocardiography (TEE) identified a large pericardial hematoma compressing the right atrium and was well tolerated by these critically ill patients. These case reports demonstrate the diagnostic value of TEE in the identification of this severe complication in the late postoperative period.