Organised Pleural Haematoma Causing Left Ventricular Compression and Tamponade-Like Pathophysiology

Pleural haematomas are rare and may arise following trauma or supratherapeutic anticoagulation. Chronic organised pleural haematomas pose diagnostic and therapeutic challenges due to their mass-like appearance and resistance to drainage. We report the case of a man in his 50s with end-stage renal disease on haemodialysis who developed progressive dyspnoea and hypotension several years after a persistent pleural effusion. Computed tomography demonstrated a pleural-based mass suspicious for malignancy, while transthoracic echocardiography revealed preserved systolic function with external compression of the left ventricular lateral wall and elevated filling pressures. An initial image-guided biopsy was inconclusive; however, subsequent surgical exploration identified an organised pleural mass containing old blood. Histology confirmed an organised haematoma with no evidence of malignancy. Unfortunately, the patient died before definitive surgical intervention. This case highlights an unusual cause of extracardiac compression mimicking malignancy and producing cardiac tamponade-like pathophysiology in the absence of pericardial disease. Early recognition using multimodal imaging is essential to prevent delays in management and adverse outcomes.