A rare presentation of intrapericardial hematoma 20 months post aortic valve replacement

We report the successful treatment of a rare case of chronic intrapericardial hematoma which presented with congestive cardiac failure 20 months after aortic valve replacement surgery for severe calcific aortic stenosis. Chest roentgenograph demonstrated paracardiac mass over lower left ventricle border, left pleural effusion and pulmonary venous hypertension. An echocardiographic study demonstrated intrapericardial mass posterolateral to left ventricle compressing left ventricular cavity both during systole and diastole causing septum to bulge into right ventricle. Computed tomography showed a loculated pericardial mass in left heart margin, left pleural effusion, bilateral axillary and mediastinal lymphadenopathy. Surgical resection was planned to relieve the symptoms and to confirm the diagnosis of the mass. The mass was completely resected through left anterolateral thoracotomy and histopathology findings confirmed the diagnosis of hematoma with cystic degeneration. Postoperative course was uneventful, and his symptoms improved markedly.