MUSEUM OF HMH MULTIMODALITY IMAGING CENTER
Lakshmi Chebrolu, Joshua McKay, Jeffrey Parker, and Karla Kurrelmeyer. Complications of Cardiac Contusion Diagnosed Using Multimodality Imaging. Methodist DeBakey Cardiovascular Journal. October 2015, Vol. 11, No. 4, pp. 253-253.doi: https://doi.org/10.14797/mdcj-11-4-253
cardiac contusion , tricuspid leaflet , echocardiography , hematoma
A 32-year-old male with a history of end-stage renal disease on hemodialysis presented to Houston Methodist Hospital with chest pain and hypotension following a motor vehicle accident. Echocardiography revealed severe right ventricular (RV) enlargement with akinesis of the RV free wall and a pericardial mass (Image 1: arrow). He had severe restriction of the posterior tricuspid leaflet and no coaptation of the tricuspid leaflets, resulting in severe tricuspid regurgitation (Image 2: dashed arrow demonstrating V wave cut-off sign). Cardiac computed tomography angiography revealed a 2 cm × 7 cm intrapericardial loculated nonenhancing fluid collection (HU 15–25 likely exudative) located anteriorly and extending superiorly to the level of the aortic arch (Image 3: H).
The patient was taken to the operating room, and the fluid collection was evacuated and sent to pathology. A 37-mm St. Jude Attune™ adjustable tricuspid annular ring (St. Jude Medical, Sylmar, CA) was placed. Pathology was consistent with a subacute hematoma (Image 4: HE sections demonstrating cardiac myocytes with myxoid change, fibrosis, chronic inflammation, fibrin deposition, and hemosiderin laden-macrophages). Patient did well and was discharged home. Follow-up imaging revealed persistent significant tricuspid regurgitation, small residual pericardial hematoma (RH), and significant dilation of the right atrium (RA) and RV (Image 5, 6: arrow points out 37-mm St. Jude Attune adjustable tricuspid annular ring).