Spontaneous Cardiac Tamponade Related to a Coronary Injury by a Pericardial Calification: a Case Report

Background Cardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management. Although etiologies are numerous, cardiac tamponade is more often due to a hemopericardium. Lethal cardiac tamponade is frequently related to a rupture of an acute myocardial infarction or to an intra-pericardial rupture of dissecting ascending aortic aneurysm. Rarely, a coronary injury may result in a hemopericardium with cardiac tamponade. Coronary artery aneurysm due to atherosclerosis, chest trauma or localized infections are the main etiologies but blunt, open chest trauma or complication of endovascular procedures have also been described. Case presentation A 83 year-old hypertensive man presented for dizziness and hypotension. The patient had oliguria and mottled skin. A severe metabolic acidosis was observed. Transthoracic echocardiography disclosed a circumferential pericardial effusion with a compressed right atrium. Contrast-enhanced thoracic CT scan confirmed the presence of the circumferential pericardial effusion. A pig-tail catheter placed within the pericardial sac allowed to withdraw 500 mL of blood, resulting in a transient improvement of hemodynamics. Rapidly, recurrent hypotension prompted a reoperation under extracorporeal circulation. An active bleeding was identified at the level of the retroventricular coronary artery. The pericardium was thickened with several “sharping” calcified plaques in the vicinity of the bleeding areas. The postoperative course was uneventful. On day 2, vasopressors were stopped and the patient was successfully extubated. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a “sharping”calcified pericardial plaque. Conclusion Cardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque.