Complicated Complication: How Interventional Radiologists Should Manage Acute Iatrogenic Cardiac Tamponade

Figures

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  Figure 1. Axial Computed Tomography of the Chest Revealing an Anterior Mediastinal Mass The figure shows an axial computed tomography of the chest, revealing an incidental anterior mediastinal mass (yellow circle).

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  Figure 2. Anatomical Depiction of Vital Structures Surrounding an Anterior Mediastinal Mass The computed tomography of the chest shows the difficulty the interventional operator would have when attempting to biopsy the anterior mediastinal mass. The sternum is the most anterior structure to the mediastinal mass. Lateral to the sternum on both sides are the left (LIMA) and right (RIMA) internal mammary arteries (smaller red dots), and they are both anterior to the mediastinal mass. The lungs are shown bilaterally, represented by the black areas, with the border of the right lung shown. Both lungs are lateral to the mediastinal mass. The main pulmonary artery (PA) and ascending aorta are posterior to the anterior mediastinal mass.

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  Figure 3. BioPince® Biopsy Device A BioPince® biopsy device was used to take samples of the anterior mediastinal mass during the procedure.

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  Figure 4. Biopsy of the Anterior Mediastinal Mass Using a Parasternal Approach The biopsy needle device was inserted just lateral of the left sternum using a parasternal approach (red arrow). This was determined to be the safest and most effect means for biopsying the anterior mediastinal mass.

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  Figure 5. Post-biopsy Acute Cardiac Tamponade A computed tomography of the axial chest after taking several samples of the anterior mediastinal mass shows acute cardiac tamponade. The blood collection can be visualized within the pericardial space (yellow arrows), between the heart (red outline) and the pericardium (blue outline).

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  Figure 6. Percutaneous Pericardial Catheter Placement The interventional operator placed a 6 French pig tail catheter within the pericardial space to relieve the gathering blood (yellow arrows).

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  Figure 7. Post-procedural Follow-up Computed Tomography Angiogram of the Chest A 48-hour post-procedural follow-up axial computed tomography angiogram of the chest shows resolution of cardiac tamponade. The computed tomography angiogram shows the lack of blood within the pericardial space, with a homeostatic heart border (red outline).