Hemopericardium

A 61-year-old woman with autosomal dominant polycystic kidney disease and polycystic liver disease requiring inferior vena cava (IVC) stent placement for intrahepatic caval compression from hepatic cysts developed pleuritic chest pain, shortness of breath, and syncope. Physical examination revealed cardiac tamponade physiology (blood pressure of 96/65 mm Hg, elevated jugular venous pressure with blunted Y-descent, Kussmaul sign, and distant heart sounds), and echocardiography confirmed a large circumferential pericardial effusion, diastolic right ventricular collapse, exaggerated respiratory variation (>25%) in the mitral inflow velocity, and normal IVC size. Pericardiocentesis returned bloody fluid. When initially aspirated fluid is bloody, it is imperative to inject agitated saline via an angiocatheter, as in this video, to ascertain that the catheter is in the pericardial space rather than a cardiac chamber. Gated cardiac computed tomography angiography showed her IVC stent fractured in multiple places with its tines protruding through the IVC into the pericardial space, causing hemopericardium. Her tamponade resolved with the pericardiocentesis, and she was treated conservatively with observation. Click the article link for more case details and additional videos.