Postoperative pericardial hematoma causing localized cardiac tamponade and presenting echocardiographically as a right atrial mass

Left atrial compression by a pericardial hematoma presenting as an obstructing intracavitary mass: a difficult differential diagnosis

IMPLICATIONS

The differential diagnosis of extracavitary, intramural and intracavitary disease may be difficult. An extrinsic compression of the left atrium by a dissecting pericardial hematoma was misdiagnosed as an intracavitary mass, by echocadiography and computer tomography. This case emphasizes the importance of patient history and clinical setting.

[Shock secondary to extrinsic compression of the right atrium by postoperative mediastinal hematoma. Pseudotumor echocardiography image in right atrium]

We present the case of a 64 year-old patient in whom an aortic Saint Jude prosthesis, a Cosgrove's mitral annulus and triple coronary artery by-pass graft were implanted, and who presented with shock related to extrinsic compression of the right atrium by a mediastinal hematoma within the first postoperative month. Transthoracic echocardiogram showed a right atrial <<Pseudo-mass>>, hampering right atrium drainage. The extrapericardial location of the hematoma is of note and was diagnosed with the aid of thoracic computerized tomography. We present the case of a 64 year-old patient in whom an aortic Saint Jude prosthesis, a Cosgrove's mitral annulus and triple coronary artery by-pass graft were implanted, and who presented with shock related to extrinsic compression of the right atrium by a mediastinal hematoma within the first postoperative month. Transthoracic echocardiogram showed a right atrial <<pseudo-mass>>, hampering right atrium drainage. The extrapericardial location of the hematoma is of note and was diagnosed with the aid of thoracic computerized tomography.

Spontaneous intramural atrial hematoma presenting as a left atrial mass

We describe an unusual case of spontaneously occurring intramural atrial hematoma with no communication with either atrium. The diagnosis of left atrial mass was made from transthoracic echocardiography. Subsequent examination with transesophageal echocardiography confirmed a large mass essentially filling the whole left atrium but failed to provide an etiologic diagnosis, which was eventually made at surgery.

Intrapericardial organized hematoma. A rare complication after open heart surgery

Intrapericardial organized hematoma, which compresses cardiac chambers late after open heart surgery, is extremely rare. We report a case of intrapericardial organized hematoma in a 63-year-old man who underwent aortic valve replacement 8 years prior, which may have aggravated rheumatic mitral valve regurgitation compressing the mitral valve anulus. Under extracardiopulmonary bypass and cardioplegic heart arrest, we removed the hematoma and replaced the mitral valve with a 27 mm St. Jude Medical valve. There were no bleeding points on the heart and pericardium at operation and no history of blunt chest trauma. The etiology of the hematoma is uncertain.

Pericardial complications of cardiac surgery: emphasis on the diagnostic role of echocardiography

Pericardial effusions are common following cardiac surgery; uncommonly they are large in size and may cause tamponade, either in the early or late postoperative period. Such effusions causing tamponade may be circumcardiac, but are frequently loculated, in which case one or more cardiac chambers is selectively compressed. Fortunately, echocardiography is capable of imaging not only the presence, location, and size of the pericardial effusion, but also indicating the presence of tamponade. Constrictive pericarditis resulting from cardiac surgery is being recognized with increasing frequency and has been associated with various echocardiographic abnormalities. This review also discusses certain other pericardial complications of cardiac surgery including supraventricular arrhythmias, chylopericardium, and posttransplant problems.