Sub-Pericardial Hematoma Following Coronary Angiography

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Introduction: A sub-pericardial hematoma is characterized by blood adjacent to the heart deep to the pericardium, which is the outer fibrous layer of the heart. A rare case demonstrates an occurrence of sub-pericardial hematoma following percutaneous coronary intervention in an individual presenting with symptoms of myocardial infarction. Initial computed tomography (CT) scan demonstrated contrast reviewed herein. Hematoma was deemed stable following serial CT scans. Case Presentation: A 76-year-old male presented with chest discomfort, shortness of breath, and bilateral pitting edema. He had a past history of coronary artery bypass grafting utilizing saphenous vein graft which required percutaneous coronary intervention to vein graft 2 years before presentation. Lab results showed elevated BNP and troponin levels. Initial diagnosis of non-ST-elevation myocardial infarction was made. The patient was taken to the catheterization lab and a 99% stenosis of the vein graft was found. Physicians faced significant challenges due to stenosis severity. Multiple pre-dilations and failed attempts to cross the stenosis occurred. Eventually, advancement of a stent was achieved. However, a perforation of the vein graft was identified, instigating prolonged balloon inflation proximal to the occlusion site. Persistent leakage at the perforation site was observed. An echocardiogram demonstrated no pericardial effusion. Continued monitoring demonstrated hemodynamic stability and repeat injections revealed decrease in flow through perforation. Imaging Outcome: A non-contrast CT chest scan was obtained to determine any evidence of significant hematoma. Within the images, a focus of contrast was identified which was concerning due to the non-contrast setting. Therefore, it was determined that the contrast was likely extravasated fluid from the PCI. Due to the appearance of this hyperdense focus, it was determined that the patient had a hematoma due to perforation of the vein graft. The sub-pericardial location was determined by the anatomical location of the hematoma by the right ventricle. Internal surveillance of hematoma occurred over the next few days. The hematoma had decreased in size and was determined stable, which led to the patients discharge. The patient had a follow-up CT scan 2 months later that demonstrated further shrinkage of the hematoma. Final Diagnosis: Sub-Pericardial Hematoma Learning Objectives 1. Recognizing a pericardial hematoma versus a pericardial effusion or hemopericardium 2. Determining the difference between an unstable and stable hematoma on imaging.

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Southern Medical Journal





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3rd Southern Medical Association's Physicians-in-Training Leadership Conference held 02/24/23 to 02/26/24 in Memphis, TN, USA.

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