Hemorrhagic Cardiac Tamponade in an End-Stage Renal Disease Patient on Apixaban

Figures

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  Figure 1. Admission 12-lead electrocardiogram shows atrial fibrillation with right bundle branch block. No clear electrical alternans is evident.

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  Figure 2. Admission chest radiograph. Portable upright anteroposterior (AP) chest radiograph showed an enlarged cardiac silhouette and mild pulmonary vascular congestion. AP projection can magnify the cardiac silhouette, limiting assessment of true cardiac enlargement.

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  Figure 3. Bedside POCUS demonstrating a large pericardial effusion. Parasternal long-axis bedside cardiac ultrasound showing a large pericardial effusion. The red arrows indicate anechoic pericardial fluid surrounding the heart. POCUS: point-of-care ultrasound

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  Figure 4. Computed tomography demonstrating a large pericardial effusion. Coronal contrast-enhanced computed tomography of the chest demonstrates a large pericardial effusion (arrow). The radiology interpretation described the effusion as possibly hemorrhagic.

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  Figure 5. Transthoracic echocardiography demonstrating a large pericardial effusion. Apical transthoracic echocardiographic view demonstrating a large pericardial effusion (blue arrow) and an increased right ventricular-to-left ventricular size ratio (red arrow). Repeat echocardiography demonstrated right ventricular compression, right atrial inversion, and respiratory variation, supporting tamponade physiology. TTE: transthoracic echocardiography; PRN: as needed