Spontaneous mediastinal hemorrhage. A complication of intracoronary streptokinase infusion for coronary thrombosis

A 72-year-old man with a recent inferior-wall myocardial infarction complicated by continued ischemic cardiac pain underwent an intracoronary streptokinase infusion in an attempt to re-establish coronary perfusion. Although the cardiac catheterization and streptokinase infusion were technically uncomplicated, signs of an enlarging mediastinal mass associated with a drop in the hematocrit reading developed in the patient 12 hours after the procedure. Aortography showed no evidence of aortic dissection or laceration. The patient was believed to have a spontaneous mediastinal hemorrhage related to streptokinase infusion.