Haemopericardium

Case contributed by Dr Vincent Tatco

Presentation

This patient recently underwent intravenous thrombolysis for an acute ischemic stroke. She was admitted 3 days prior for an acute myocardial infarction with ventricular tachycardia. She presented with hypotension during admission. Echocardiography showed a massive pericardial effusion.

Patient Data

Age: 55 years
Gender: Female
Modality: X-ray

The cardiac silhouette is markedly enlarged consistent with massive pericardial effusion.

Left-sided pleural effusion and subsegmental atelectasis are also demonstrated.

Modality: CT

There is a dense (+65 Hounsfield units) pericardial fluid collection consistent with haemopericardium.

A drain is seen inserted at the subxiphoid region with its tip positioned in the anterior pericardial space. 

Bilateral pleural effusions with atelectatic changes in both lungs are also demonstrated.

Case Discussion

Haemopericardium is a known, but rarely reported, complication of thrombolytic therapy. In this case, the acute ischemic stroke patient has an underlying myocardial disease that posed a risk for hemopericardium and life-threatening cardiac tamponade after thrombolytic therapy.

A subxiphoid pericardial window relieved the tamponade, and the patient made a good recovery.

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Case Information

rID: 50577
Case created: 12th Jan 2017
Last edited: 14th Jan 2017
Systems: Cardiac, Chest
Inclusion in quiz mode: Included

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