Acute Mediastinal Bleeding with Pleural Escape: Case Report of a Rare Interventional Complication with Unusual Resolve

Author:

Widodo Wishnu Aditya1,Mansjoer Arif2,Dilawar Ismail3,Kurnia Andri4,Ruslim Daniel5

Affiliation:

1. Division of Interventional Cardiology, Jakarta Heart Center, Jakarta, Indonesia

2. Division of Cardiac Intensive Care, Jakarta Heart Center, Jakarta, Indonesia

3. Division of Cardiothoracic Surgery, Jakarta Heart Center, Jakarta, Indonesia

4. Division of Cardiac Anesthesia, Jakarta Heart Center, Jakarta, Indonesia

5. Division of Radiology, Jakarta Heart Center, Jakarta, Indonesia

Abstract

AbstractAcute mediastinal bleeding is a very rare complication of cardiac intervention. It is a life-threatening situation when this condition causes acute compression of the mediastinal area. A 59-year-old man was diagnosed with inferior ST-elevation myocardial infarction with ongoing chest pain and underwent an urgent percutaneous coronary intervention procedure. After coronary stent was implanted, patient complained of chest tightness, and suffocation, blood pressure dropped, O2 saturation dropped, and was difficultly intubated. Image acquisition by C-arm showed a large bulging in aortic arch area. Contrast-enhanced computed tomography ruled out aortic dissection, but noted a large mediastinal mass that was radiated to the neck. The bulging was spontaneously regressed, and a large left pleural effusion was developed. Left pleural tapping was performed on day 7, and a total of 1.5-L hemorrhagic fluid was evacuated. In our case, unusual drainage from mediastinal to pleural space has probably save the patient.

Publisher

Georg Thieme Verlag KG

Subject

Cardiology and Cardiovascular Medicine

Reference11 articles.

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4. Subclavian artery perforation and mediastinal hematoma following transradial percutaneous coronary intervention;G S Gulsin;J Am Coll Cardiol,2021

5. Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation;L YY Yeung;Trauma Surg Acute Care Open,2016

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