Background
Regional cardiac tamponade presented as posterior extrapericardial hematomas compressing both atria, with cardiogenic obstructive shock due to inflow abolition is a rare cause of post PCI vascular collapse.
Case summary
We present such a case where CT-guided anterior pericardiocentesis decompressed the atria and restored cardiac output.
Discussion
Prior CABG should not be considered protective from cardiac tamponade in patients in whom perforation occurs, because loculated effusions can develop beneath adhesions of the pericardium and compress various cardiac structures (such as the left atrium or the right ventricle); they appear several hours after the intervention and cause atypical hemodynamic manifestations.