Cardiac Tamponade From Inferior Vena Cava (IVC) Stent Fracture скачать в хорошем качестве

Cardiac Tamponade From Inferior Vena Cava (IVC) Stent Fracture

A 61-year-old woman with autosomal dominant polycystic kidney disease (PCKD) and polycystic liver disease requiring IVC stent placement for intrahepatic caval compression from hepatic cysts developed pleuritic chest pain, shortness of breath, and syncope. Physical examination revealed cardiac tamponade physiology (blood pressure of 96/65 mm Hg, elevated jugular venous pressure with blunted Y-descent, Kussmaul sign, and distant heart sounds), and echocardiography confirmed a large circumferential pericardial effusion, diastolic right ventricular collapse, exaggerated respiratory variation (greater than 25%) in the mitral inflow velocity, and normal IVC size. Pericardiocentesis returned bloody fluid. Gated cardiac computed tomography angiography showed her IVC stent fractured in multiple places with its tines protruding through the IVC into the pericardial space, causing hemopericardium. This video illustrates a 3-dimensional computed tomography reconstruction showing the IVC stent impinging on the pericardium near the coronary sinus. Her tamponade resolved with the pericardiocentesis, and she was treated conservatively with observation. See https://ja.ma/2Gqn0Ed for an echocardiogram video demonstrating her pericardial effusion, https://ja.ma/2TKeibG for an echocardiogram video confirming the pericardiocentesis catheter was properly placed in the pericardial space prior to pericardiocentesis, and https://ja.ma/38rcjgs for full case details and discussion.