Post-Bentall procedure 'pseudo' pulmonary embolism, cardiac tamponade in disguise: a case report

Post-operative cardiac complications require rapid evaluation, which may be hindered by various challenges. Sudden shortness of breath with persisting haemodynamic failure after cardiac procedure is often associated with cases of pulmonary embolism or cardiac tamponade that have contradicting therapies. Anticoagulant therapy is the treatment of choice for pulmonary embolism; however, it could worsen pericardial effusion where bleeding control and clot evacuation are the mainstays of treatment. In this study, we present a case of late cardiac complication due to cardiac tamponade mimicking signs of pulmonary embolism.

A 45-year-old male with aortic dissection DeBakey type-II, 7 day post-Bentall procedure, presented with sudden shortness of breath and persistent shock despite therapy. Initial assessment directed towards pulmonary embolism was supported by hallmark imaging signs from X-ray and transthoracic echocardiography evaluation. However, computed tomography scan results were suggestive of cardiac tamponade mainly accumulating at the right side of the heart, compressing the pulmonary artery and vena cava confirmed by transoesophageal echocardiography, thus mimicking the findings of pulmonary embolism. After clot evacuation procedure, the patient improved clinically and was discharged the following week.

In this study, we highlight a case of cardiac tamponade with classical findings of pulmonary embolism after an aortic replacement procedure. Physicians should carefully analyse a patient's clinical history, physical, and supporting examinations to direct and change the course of therapy accordingly, as these two complications have opposite therapy principles and may exacerbate the patient's condition.