Right coronary arterial rupture during angioplasty with resultant right haemothorax

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Chest Radiograph obtained after complex percutaneous angioplasty.

Patient Data

Age: 91
Gender: Female

What can go wrong during complex PCI procedure?

Modality: X-ray

New right layering pleural effusion, Then the smart radiology resident Dr. Yuyang Zhang reviewed chart which was incomplete. So he called the cardiology fellow.

 

Then we got history of RCA rupture in cath lab requiring a covered stent of the dissection. Meanwhile since there was prior CABG ,so no tamponade and the blood went to the right pleural space from the pericardiac space. I suppose it could have gone to the left pleural space too, This is the first such one in our collection.

Patient was lucky. See conrast in kidneys from cardiac cath.

Have you seen this complicaton of RCA angioplasty.

Modality: CT

There is a large right pleural effusion, with associated near complete collapse of the right lower lobe. The density of the layering pleural effusion is increased concerning for complicated fluid , recent contrast from PTCA of RCA and or blood products

Informed consent was obtained; the patient was placed on the examination table in sitting position and site was marked; team verification of patient identification, procedure, and site was performed.

Ultrasound interrogation of the right hemithorax was performed; a pleural effusion was present and multiple ultrasound images were recorded. The right side of the back was prepped and
draped in usual sterile fashion. 2% plain lidocaine was infiltrated into a lower right intercostal space. Access to the posterior pleural  space was obtained using real-time ultrasound guidance and a thoracentesis catheter. A total of 500 ml of sanguinous (frankly bloody) pleural fluid was aspirated. The patient tolerated the procedure well.
 

Case Discussion

Though the radiology resident called the finding immediately. It took us 3 more days for us to convince cardiology to act on the hemothorax to do CT and thoracocentesis.

 

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Case Information

rID: 39278
Case created: 29th Aug 2015
Last edited: 21st Sep 2016
Inclusion in quiz mode: Included

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