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(Circulation. 1998;98:183.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pericardial Hematoma After Primary Angioplasty Complicated by Coronary Rupture

Christian Zellner, MD; Tony M. Chou, MD; Charlie Higgins, MD; Rod Kaiser, MD, PhD; ; Nelson B. Schiller, MD

From the Department of Medicine, Cardiology Division, and the Cardiovascular Research Institute, University of California, San Francisco, Moffitt-Long Hospitals; the Department of Radiology, University of California, San Francisco, Moffitt-Long Hospitals (C.H.); and the Santa Cruz Medical Clinic, Santa Cruz, Calif (R.K.).

Correspondence to Nelson B. Schiller, MD, Division of Cardiology and the Cardiovascular Research Institute, University of California, San Francisco, M-314A Moffitt-Long Hospitals, Box 0214, San Francisco, CA 94143-0214. E-mail schiller@cardio.ucsf.edu

Coronary artery rupture is a rare complication of percutaneous transluminal coronary angioplasty. Most patients undergo emergency bypass surgery, so the natural course of these events remains unclear. The following images demonstrate a pericardial hematoma, caused by perforation of the right coronary artery. A 59-year-old man underwent primary angioplasty during inferior myocardial infarction. Perforation of the right coronary artery was noted, with extravasation of contrast (Figure), and was treated conservatively. Nine months later, the patient was referred for evaluation of a pericardial mass. MRI images and transthoracic echocardiogram demonstrate a noncommunicating intrapericardial hematoma. The patient remains symptom free.

View larger version (145K): [in this window] [in a new window]   Figure 1. Top left, Coronary angiography demonstrated a proximal occlusion of right coronary artery with guidewire (arrow) penetration and extravasation of contrast medium. Bottom left, Transthoracic echocardiographic images showed a large, extrinsic, heterogeneous, spherical, intrapericardial mass (6.8x7.2 cm), contiguous with the atrioventricular groove, impinging on the right atrial cavity. It was encapsulated in appearance. No hemodynamic compromise could be shown. The mass had discrete foci of internal calcification and channel-like internal communications without evidence of blood flow by Doppler during signal enhancement with intravenous contrast (Albunex). The large mass showed no evidence of continuous flow with large vessels or cardiac chambers. Top right, Spin-echo ECG-gated MRI image (TR/TE, 869/11 ms) in the transaxial plane shows a heterogeneous-signal-intensity mass adjacent to right atrioventricular groove with compression of right atrium and ventricle. A low-intensity rim (black arrow) and internal regions of high signal intensity (arrow) are diagnostic for subacute-to-chronic hematoma. Bottom right, Spin-echo ECG-gated . . . [Full Text of this Article]

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