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Multiple pericardial hematomas: a case report and mini-review in multimodality imaging
Aninka Saboe1, Ferdy Sanjaya2, Raden Erwin Affandi Soeriadi3
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, Indonesia. aninka.saboe@unpad.ac.id.
BMC Medical Imaging
|May 19, 2021
Summary
Multiple pericardial hematomas, rare after cardiac surgery, present diagnostic challenges. Multi-modality cardiac imaging, including CT and MRI, is crucial for accurate diagnosis and management of these incidental findings.
Area of Science:
- Cardiology
- Radiology
- Pathology
Background:
- Pericardial hematoma, a rare condition involving blood accumulation in the pericardial space, can occur post-cardiac surgery.
- Clinical diagnosis is challenging, necessitating advanced cardiac imaging for identification.
Observation:
- A case of multiple pericardial hematomas incidentally found in a patient one month post-atrial septal defect closure.
- Initial echocardiography and CT scans revealed masses with atypical features, raising differential diagnoses including intracardiac thrombus and pericardial neoplasm.
- Further investigation with SPECT/CT and cardiac MRI was performed due to ambiguous findings and patient's refusal of biopsy.
Findings:
- Cardiac CT showed masses with 30-40 HU attenuation, but indistinct borders near the right atrium.
- SPECT/CT excluded intracardiac thrombus by showing a filling defect without increased radioactivity.
- Cardiac MRI confirmed subacute pericardial hematomas, characterized by low T1 and high T2 signal intensities without gadolinium enhancement.
Implications:
- Pericardial hematomas should be considered in the differential diagnosis of pericardial masses following cardiac surgery.
- Multi-modality cardiac imaging is essential for diagnosing atypical presentations of pericardial hematomas.
- Asymptomatic patients with stable hemodynamics and resolved hematomas require careful follow-up.
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