Open Access Case report

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

Anne Cypierre1, Francis Pesteil2, Claude Cassat3, François Parraf4, Rémy Bellier1, Lionel Ursulet1, Claire Eveno2, Philippe Vignon1 and Bruno François1*

Author Affiliations

1 Service de Réanimation Polyvalente, CHU Dupuytren, 2 avenue Martin Luther King, Limoges 87042, France

2 Service de Chirurgie Thoracique et Cardio-vasculaire, CHU Dupuytren, 2 avenue Martin Luther King, Limoges 87042, France

3 Service de Cardiologie, CHU Dupuytren, 2 avenue Martin Luther King, Limoges 87042, France

4 Service d'Anatomopathologie, CHU Dupuytren, 2 avenue Martin Luther King, Limoges 87042, France

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BMC Cardiovascular Disorders 2012, 12:28  doi:10.1186/1471-2261-12-28

Published: 25 April 2012

Abstract

Background

Cardiac 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 presentation

A 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.

Conclusion

Cardiac 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.

Keywords:
Hémopéricardium; Tamponade; Chronic péricarditis; Coronary artery