Emergent surgical exploration and repair successfully treated a 56-year-old man presenting with pericardial tamponade secondary to a rare dissecting posterior descending artery aneurysm.
Case Report (n=1)
This case highlights a rare etiology of pericardial tamponade due to posterior descending artery dissection and aneurysm, emphasizing the need for prompt surgical exploration.
Abstract Introduction Cardiac tamponade most frequently results from malignancy, infection, or trauma. Coronary artery dissection or rupture leading to hemopericardium is exceedingly rare and typically involves the left anterior descending or right coronary artery.1 Involvement of the posterior descending artery (PDA) is uncommon and seldom reported. We present a rare case of pericardial tamponade secondary to a dissecting PDA aneurysm masquerading as a pericardial mass. Case Presentation A 56-year-old man with uncontrolled diabetes, atrial fibrillation, and recent pericarditis treated with colchicine and prednisone presented with dyspnea, chest pain, and lower-extremity edema. Physical exam revealed elevated jugular venous pressure, diminished breath sounds, and muffled heart sounds. Echocardiography demonstrated a small pericardial effusion and an echogenic mass compressing the right atrium and ventricle. Chest CT showed a 6.1 × 6.5 × 4.5 cm soft-tissue density arising from the inferior pericardium, producing mass effect on the right heart. Emergent mediastinal exploration revealed a large organized pericardial hematoma causing tamponade that was drained. A dissecting aneurysm of the PDA was identified as the bleeding source and repaired surgically, with resection of thickened pericardium. The patient recovered well, was extubated postoperatively, and discharged on day 7. Follow-up coronary angiography due to anginal pain demonstrated high-grade lesion 99% in the proximal circumflex vessel revascularized with a Medtronic onyx 45 x 15 stent post dilated with a 5 0 NC balloon. His previously noted low ejection fraction normalized, and the PDA appeared intact. No connective tissue, autoimmune, or vasculitic disorder was identified. Discussion Spontaneous coronary artery dissection leading to tamponade is an exceptionally rare event, and PDA involvement has been reported in isolated cases.2 Pericardial hematomas from vascular rupture can mimic neoplastic or inflammatory pericardial masses. 3 Recognition of this possibility is critical, as delay in intervention can be fatal. Prompt surgical exploration is both diagnostic and lifesaving, while postoperative angiography aids in excluding recurrent dissection or aneurysm formation. Early diagnosis and timely management can restore normal cardiac function and prevent recurrence. This case highlights a rare etiology of pericardial tamponade due to PDA dissection and aneurysm. Clinicians should maintain suspicion for vascular causes when evaluating atypical pericardial masses or effusions. References: 1. Saw J. Coronary artery dissection in women: acute management and long-term outcomes. Eur Heart J. 2020;41(22):2132-2140. 2. Al-Mufarrej F, et al. Spontaneous coronary artery dissection causing cardiac tamponade. Ann Thorac Surg. 2017;103(1):e1-e3. 3. Pineda AM, et al. Intrapericardial hematoma mimicking pericardial tumor. Circulation. 2018;138(12):1272-1275. This abstract is funded by: None
Gul et al. (Fri,) conducted a case report in Pericardial tamponade secondary to posterior descending artery dissection (n=1). Emergent mediastinal exploration and surgical repair was evaluated. Emergent surgical exploration and repair successfully treated a 56-year-old man presenting with pericardial tamponade secondary to a rare dissecting posterior descending artery aneurysm.