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A Pressing Matter: Compressive Postoperative Hematoma Causing Acute Diastolic Heart Failure
Megan Winters1, Bryan Ezema2, Chinwe Ogedegbe1
1Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, New Jersey.
The Journal of Emergency Medicine
|November 11, 2022
Summary
Postoperative patients may experience serious cardiopulmonary complications after discharge. An esophageal hematoma caused heart failure in one patient, highlighting the need for broad differential diagnoses in the emergency department.
Area of Science:
- Emergency Medicine
- Cardiology
- Gastroenterology
Background:
- Postoperative cardiopulmonary complications contribute significantly to patient morbidity and mortality.
- A substantial percentage of postoperative complications manifest after hospital discharge, necessitating readmission.
- Emergency department (ED) presentations in postoperative patients require consideration of multi-systemic complications, including those affecting adjacent organs.
Observation:
- A 54-year-old woman presented to the ED with shortness of breath post-Nissen fundoplication revision.
- Initial pulmonary angiography revealed a hiatal hernia but ruled out pulmonary embolism.
- The patient returned with worsening symptoms, leading to the diagnosis of an esophageal hematoma compressing the left atrium.
Findings:
- Esophageal hematoma causing extrinsic compression of the left atrium.
- Acute diastolic heart failure secondary to left atrial compression.
- Pulmonary angiography was negative for pulmonary embolism but showed a large hiatal hernia.
Implications:
- Emergency physicians must consider diverse etiologies for postoperative symptoms presenting to the ED.
- Prompt consultation with the surgical team is crucial for accurate diagnosis and management.
- This case underscores the importance of a comprehensive diagnostic approach in postoperative patients with emergent complaints.
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