Obstructive shock with mediastinal hematoma caused by chest compressions after successful primary percutaneous coronary intervention

Profile and outcomes of patients with mediastinal hematoma after cardiac catheterization: A retrospective analysis

OBJECTIVE

To provide a comprehensive introduction of mediastinal hematoma.

BACKGROUND

Mediastinal hematoma is a rare complication that is usually not considered in the differential diagnosis of chest pain after cardiac catheterization.

METHODS

From January 1, 2006, to December 31, 2013, at Fuwai Hospital, 126,265 patients underwent coronary angiography (CAG); 121,215 of them underwent CAG via the radial artery. Ultimately, 10 patients with mediastinal hematoma due to cardiac catheterization were included. Patients' clinical characteristics, diagnosis, treatment, and prognosis were retrospectively analyzed.

RESULTS

The incidences of mediastinal hematoma in cardiac catheterization and transradial cardiac catheterization were 0.79‱ and 0.74‱, respectively. A super slide hydrophilic guidewire was used in all 10 patients with mediastinal hematoma. These patients felt chest pain and dyspnea during/after the procedure, and computed tomography (CT) was used to diagnose mediastinal hematoma. Among them, two patients had a neck hematoma. The post-procedural hemoglobin level decreased substantially in all patients. Antiplatelet therapy was discontinued for 8-20 days in three patients without stents implanted, and then only oral aspirin was prescribed. Aspirin was transiently discontinued for 2 days in one patient undergoing percutaneous coronary intervention. The others continued taking dual antiplatelet drugs. Two patients received blood transfusion. There was no case of stent thrombosis, and surgery was not indicated for any patient. No complication was observed after discharge during the 9.0 ± 2.5-year follow-up.

CONCLUSION

CT should be performed as early as possible in patients with suspected mediastinal hematoma. The prognosis of mediastinal hematoma is usually good with early diagnosis and suitable therapy.

A Mediastinal Hematoma after the Bentall Operation Detected by Transthoracic Echocardiography

A round, well-defined mass was incidentally detected at follow-up transthoracic echocardiography in an asymptomatic 36-year-old man with a history of Bentall operation 8 months earlier. Computed tomography angiography of the aorta demonstrated a mediastinal hematoma below the pulmonary artery in the mid-mediastinum. Although mediastinal hematomas are hard to detect after cardiac surgery via transthoracic echocardiography, the probable presence of this complication should be kept in mind during echocardiography.