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

Abstract

Computed tomography guided biopsies are common interventional procedures that are necessary for confirmation of imaging findings. Additionally, percutaneous biopsies are necessary for the elucidation of a patient’s clinical findings with disease pathology. Though interventionists perform these procedures regularly without consequence, various complications may arise depending on the tissues biopsied. Examples of such complications may include hemorrhage, hematoma formation, or perforation of surrounding vessels. In the case of mediastinal biopsies, less common but higher-risk complications may include pneumothorax, perforation of arterial vessels, and damage to the cardiac tissues resulting in decompensation. Interventionists should understand the risks of performing these procedures and should be prepared to intervene if life-threatening complications arise. As interventional cardiologists are often prepared to manage decompensating cardiac complications, interventional radiologists must likewise anticipate the same to occur when conducting procedures that may affect cardiac tissues. The following case demonstrates a technique for correcting a complicated complication arising from a mediastinal biopsy, which resulted in a pericardial effusion and patient decompensation.

Pericardial Tamponade during Supra Hepatic IVC Angioplasty in Budd-Chiari Syndrome Managed by Ultrasound-Guided Pericardiocentesis

“…1 2 The endovascular procedure with highest incidence of pericardial hemorrhage includes IVC filter with strut fracture/migration. 3 Other causes excluding intracardiac/coronary procedures include mediastinal biopsies, 4 aortic stent-graft placement, 5 and central venous port insertion. 6 IVC-RA junction is in close relation with the pericardium that forms a recess around the vena cava.…”