Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature

Abstract

Background Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening. Case presentation A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period. Conclusions Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.

Mediastinal and Thoracic Hematoma Following Transradial Cerebral Angiography: a Case Report

“…Nevertheless, the TRA has its own limitations and may cause complications including radial artery spasm or occlusion, forearm hematoma induced by radial artery perforation, and even such severe complications as subclavian artery (SCA) entrapment and perforation of the brachiocephalic trunk (BCT), the thyroid carotid artery or internal mammary artery [4,5] . Previous reports indicated that the occurrence of hematomas in the thorax during angiography were mostly related to inappropriate manipulation of the hydrophilic guidewires [6,7] . In theory, both the wires and catheter can cause injuries to any branch of the arteries along their path to result in artery perforation and bleeding.…”

Mediastinal hematoma after trans-radial cerebral angiography: a case report

“…A review of the literature, particularly from the cardiovascular field, reveals that mediastinal hematoma as a complication of the trans-radial procedure, though rare, is not unprecedented. Studies such as those by Jao et al and Wang et al have documented similar complications, underscoring the potential for significant vascular trauma even with the most meticulous catheter and guidewire manipulation [ 9 , 10 ]. These reports highlight the clinical spectrum of hematoma development following trans-radial access, ranging from localized hematomas to extensive vascular injuries necessitating emergency interventions.…”