Post-operative intrapericardial hematoma presenting as isolated right atrial tamponade

A 57-year-old male underwent mechanical mitral valve replacement for severe mitral regurgitation of a prolapsed myxomatous mitral valve. The patient's post-operative recovery period was uneventful until the eighth day when he decompensated into pulseless electrical activity arrest. A bedside transthoracic echocardiogram revealed a large, smooth-edged mass nearly obliterating the right atrial cavity. Color Doppler demonstrated flow within the right atrium around the mass. After computed tomography scan showed that an intrapericardial hematoma was extrinsically compressing the right atrium, the patient underwent emergent mediastinal exploration with evacuation of 700 ml of coagulated blood. The patient made a full recovery. <Learning objective: Loculated intrapericardial hematoma is an infrequently encountered but serious complication of cardiac surgery that may lead to life-threatening cardiac tamponade. When clinically suspected, computed tomographic imaging or transesophageal echocardiography may be useful to confirm diagnosis. Hemodynamically significant intrapericardial hematoma should be treated by urgent surgical evacuation.>.