Cardiac tamponade related to a coronary injury by a pericardial calcification: an unusual complication

BMC Cardiovascular Disorders

Case Report

François Parraf¹  Claude Cassat²  Claire Eveno³  Francis Pesteil³  Anne Cypierre⁴  Philippe Vignon⁴  Bruno François⁴  Rémy Bellier⁴  Lionel Ursulet⁴ 

[1] Service d'Anatomopathologie, CHU Dupuytren, 2 avenue Martin Luther King, 87042, Limoges, France;Service de Cardiologie, CHU Dupuytren, 2 avenue Martin Luther King, 87042, Limoges, France;Service de Chirurgie Thoracique et Cardio-vasculaire, CHU Dupuytren, 2 avenue Martin Luther King, 87042, Limoges, France;Service de Réanimation Polyvalente, CHU Dupuytren, 2 avenue Martin Luther King, 87042, Limoges, France;

关键词: Hémopéricardium;    Tamponade;    Chronic péricarditis;    Coronary artery;   

DOI  :  10.1186/1471-2261-12-28

 received in 2011-12-12, accepted in 2012-04-25,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundCardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management. Although etiologies are numerous, cardiac tamponade is more often due to a hemopericardium. Rarely, a coronary injury may result in such a hemopericardium with cardiac tamponade. Coronary artery aneurysm are the main etiologies but blunt, open chest trauma or complication of endovascular procedures have also been described.Case presentationA 83-year-old hypertensive man presented for dizziness and hypotension. The patient had oliguria and mottled skin. Transthoracic echocardiography disclosed a circumferential pericardial effusion with a compressed right atrium, confirmed by contrast-enhanced thoracic CT scan. A pig-tail catheter allowed to withdraw 500 mL of blood, resulting in a transient improvement of hemodynamics. Rapidly, recurrent hypotension prompted a reoperation. An active bleeding was identified at the level of the retroventricular coronary artery. The pericardium was thickened with several "sharping" calcified plaques in the vicinity of the bleeding areas. On day 2, vasopressors were stopped and the patient was successfully extubated. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a "sharping"calcified pericardial plaque.ConclusionCardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque.

【 授权许可】

Unknown   
© Cypierre et al; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.