Presentation
3 days of "indigestion". His head, neck, shoulders, and arms are swollen and purple.
Patient Data
Portable CXR shows pulmonary hypoinflation, but no edema or pneumonia. The cardiomediastinal silhouette is grossly normal.
Chest CT angiogram shows a dense pericardial effusion, likely a hemopericardium, compressing the right ventricle. There is a blood/contrast level in both the superior and inferior vena cavae. The thoracic aorta is normal in course and caliber with no dissection.
An intraoperative photograph shows a jet of blood (dashed green circle) exiting a defect in the lateral left ventricular myocardium.
Intraoperative movie loop confirms a left ventricular defect with active bleeding.
Intraoperative movie loop confirms successful repair of a left ventricular defect.
Case Discussion
This patient presented with a 3-day history of "indigestion", which was due to a lateral left ventricular wall myocardial infarction. At presentation, he was dyspneic and his head, neck, shoulders, and arms were swollen and purple. A CT angiogram of the chest was obtained to rule out aortic dissection after an echocardiogram showed a pericardial effusion. The CT confirmed a dense pericardial effusion, suspicious for hemopericardium. Causes for hemopericardium include rupture of a type A dissection into the pericardium, rupture of a coronary artery aneurysm, and left ventricular rupture following myocardial infarction. The blood/contrast level in the SVC/IVC is a grave prognostic sign indicating severe compromise in the flow of blood into and through the heart. Compression of the right ventricle confirms impaired cardiac filling/diastole. The intraoperative photograph and movie loop shows a jet of blood exiting the ruptured lateral wall of the left ventricle. The defect was successfully repaired.
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