Haemomediastinum, haemopericardium and haemothorax caused by elective transradial coronary angiography in a rare Kommerell’s diverticulum
Haemomediastinum, haemopericardium and haemothorax caused by elective transradial coronary...
Fang, Hsiu-Yu; Wu, Chiung-Jen
2010-04-01 00:00:00
European Journal of Cardio-thoracic Surgery 37 (2010) 957 www.elsevier.com/locate/ejcts Images in cardio-thoracic surgery Haemomediastinum, haemopericardium and haemothorax caused by elective transradial coronary angiography in a rare Kommerell’s diverticulum Hsiu-Yu Fang, Chiung-Jen Wu Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao sung hsiang, Kaohsiung Hsien, Taiwan, ROC Received 18 October 2009; received in revised form 29 October 2009; accepted 2 November 2009; Available online 28 November 2009 Keywords: Kommerell’s diverticulum; Transradial; Coronary angiography; Haemomediastinum; Haemopericardium; Haemothorax A 47-year-old male was referred for coronary intervention subclavian artery (Fig. 1). Chest computed tomography via left radial approach. After heparin administration, the showed haemomediastinum, haemopericardium and hae- coronary lesion was treated. He developed hypotension and mothorax (Fig. 2). After protamine infusion and blood dyspnoea. An angiogram showed extravasation at the left transfusion, he stabilised and was discharged 2 days later. Fig. 1. (A) A hydrophilic wire (Terumo 0.035) (black arrow) at junction of the left subclavian artery and the descending aorta trying to advance to the ascending aorta. (B) After wire advancing failure, sequential contrast injection showed extravasation at junction of the left subclavian artery and the descending aorta (black arrow). We changed to right radial artery approach for coronary intervention. Fig. 2. (A) Chest X-ray after coronary stenting showed widening of medias- tinum and cardiomegaly. It also revealed some fluid accumulation especially at left lower pleural space. (B) Chest computed tomography (CT) showed sig- nificant haemomediastinum, haemopericardium (white arrow) and hae- mothorax. (C) At 1-year follow-up, the saggital cut of reconstructed chest CT revealed the left subclavian artery joining to the descending aorta (black arrow), presence of lateral wall irregularity and focal haziness compatible with previous vascular injury. (D and E) At 1-year follow-up, chest X-ray and chest CT showed dextro-cardia and complete resolution of haemomediasti- num, haemopericardium and haemothorax. (F) Reconstructed 3D chest CT identified the anomaly of right side aortic arch with 1st branch supplying to left common carotid artery (white dotted arrow), 2nd and 3rd branch supplying to the right common carotid artery and the right subclavian artery respectively. * Corresponding author. Tel.: +886 7 7317123x2363; The 4th branch origin showed a Kommerell’s diverticulum and giving rise to left fax: +886 7 7317123x2355. subclavian artery (white arrow). E-mail addresses: cvcjwu@adm.cgmh.org.tw, ast42aiu@hotmail.com (C.-J. Wu). 1010-7940/$ — see front matter # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejcts.2009.11.005
http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.pngEuropean Journal of Cardio-Thoracic SurgeryOxford University Presshttp://www.deepdyve.com/lp/oxford-university-press/haemomediastinum-haemopericardium-and-haemothorax-caused-by-elective-bJI0AOs6k6
Haemomediastinum, haemopericardium and haemothorax caused by elective transradial coronary angiography in a rare Kommerell’s diverticulum
European Journal of Cardio-thoracic Surgery 37 (2010) 957 www.elsevier.com/locate/ejcts Images in cardio-thoracic surgery Haemomediastinum, haemopericardium and haemothorax caused by elective transradial coronary angiography in a rare Kommerell’s diverticulum Hsiu-Yu Fang, Chiung-Jen Wu Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao sung hsiang, Kaohsiung Hsien, Taiwan, ROC Received 18 October 2009; received in revised form 29 October 2009; accepted 2 November 2009; Available online 28 November 2009 Keywords: Kommerell’s diverticulum; Transradial; Coronary angiography; Haemomediastinum; Haemopericardium; Haemothorax A 47-year-old male was referred for coronary intervention subclavian artery (Fig. 1). Chest computed tomography via left radial approach. After heparin administration, the showed haemomediastinum, haemopericardium and hae- coronary lesion was treated. He developed hypotension and mothorax (Fig. 2). After protamine infusion and blood dyspnoea. An angiogram showed extravasation at the left transfusion, he stabilised and was discharged 2 days later. Fig. 1. (A) A hydrophilic wire (Terumo 0.035) (black arrow) at junction of the left subclavian artery and the descending aorta trying to advance to the ascending aorta. (B) After wire advancing failure, sequential contrast injection showed extravasation at junction of the left subclavian artery and the descending aorta (black arrow). We changed to right radial artery approach for coronary intervention. Fig. 2. (A) Chest X-ray after coronary stenting showed widening of medias- tinum and cardiomegaly. It also revealed some fluid accumulation especially at left lower pleural space. (B) Chest computed tomography (CT) showed sig- nificant haemomediastinum, haemopericardium (white arrow) and hae- mothorax. (C) At 1-year follow-up, the saggital cut of reconstructed chest CT revealed the left subclavian artery joining to the descending aorta (black arrow), presence of lateral wall irregularity and focal haziness compatible with previous vascular injury. (D and E) At 1-year follow-up, chest X-ray and chest CT showed dextro-cardia and complete resolution of haemomediasti- num, haemopericardium and haemothorax. (F) Reconstructed 3D chest CT identified the anomaly of right side aortic arch with 1st branch supplying to left common carotid artery (white dotted arrow), 2nd and 3rd branch supplying to the right common carotid artery and the right subclavian artery respectively. * Corresponding author. Tel.: +886 7 7317123x2363; The 4th branch origin showed a Kommerell’s diverticulum and giving rise to left fax: +886 7 7317123x2355. subclavian artery (white arrow). E-mail addresses: cvcjwu@adm.cgmh.org.tw, ast42aiu@hotmail.com (C.-J. Wu). 1010-7940/$ — see front matter # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejcts.2009.11.005
Journal
European Journal of Cardio-Thoracic Surgery
– Oxford University Press
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