CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2018 Luglio-Agosto;5(4):523-8

DOI: 10.23736/S2283-8376.18.00104-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Subepicardial hematoma: a rare complication after percutaneous coronary intervention

Veronica COSI ✉, Roberta IOPPOLO, Domenico ATTINÀ, Camilla SPORTOLETTI, Fabio NIRO, Luigi LOVATO

Sezione di Radiologia Cardiotoracica, Dipartimento Cardio-Toraco-Vascolare, Policlinico Universitario Sant’Orsola-Malpighi, Bologna, Italia

Percutaneous coronary intervention (PCI) is considered nowadays the gold standard for treatment of coronary lesions, even if it may lead to some complications. One to be taken with high consideration is coronary artery perforation, with subsequent development of subepicardial (or intramyocardial) hematoma, condition quite rare but at the same time burdened by a high mortality rate, if not promptly recognized and treated. However, subepicardial or intramyocardial hematomas may occur also after myocardial infarction, thrombolytic therapy, chest trauma, coronary artery bypass operation or cardiac surgery, but they can also develop spontaneously. Procedure-related intramyocardial hematoma is generally associated with guidewire- or balloon-induced coronary perforation, especially in patients on antithrombin and antiplatelet therapy. Clinical outcomes of intramyocardial hematoma may vary from asymptomatic remission to cardiac death accordingly the best therapeutic management depends on the clinical situation. Surgical treatment is traditionally recommended in case of cardiac tamponade or cardiac chamber compression due to hematoma. Conservative management is the most appropriate option for clinically stable patients using non-invasive imaging follow-up such as cardiac CT, MRI or serial echocardiographic examination until the complete resolution of the hematoma. We describe here a rare case of a subepicardial hematoma occurred in a 78-year-old man after PCI with balloon angioplasty and stenting of the proximal right coronary artery (RCA). The patient was treated conservatively with a successful outcome.

KEY WORDS: Hematoma - Myocardial infarction - Percutaneous coronary intervention - Cardiac imaging techniques