Atypical Ellis type III coronary artery perforation can present as a compressive subepicardial hematoma with minimal pericardial effusion, requiring prompt recognition by echocardiography and emergency surgical intervention.
Alerts to subepicardial hematoma as tamponade mimic in type III CAP; hypothesis-generating for rare PCI complications.
Iatrogenic coronary artery perforation (CAP) is a rare but critical complication of percutaneous coronary intervention (PCI). While Ellis type III CAP typically causes massive pericardial effusion and acute cardiac tamponade, herein, we report an atypical case of type III coronary artery perforation in a 71-year-old male patient during PCI. The patient presented with hemodynamic instability mimicking cardiac tamponade. Imaging revealed a subepicardial hematoma on the right ventricular surface with only a small amount of pericardial effusion. The patient was successfully rescued by emergency coronary artery bypass grafting combined with hematoma evacuation.
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Bao et al. (2026) studied this question.
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