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Case Reports
. 2024 Mar 23;19(1):151.
doi: 10.1186/s13019-024-02624-y.

Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report

Xiaohong Zhao  1   2 , Kang Wang  3   4
Affiliations
Case Reports

Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report

Xiaohong Zhao et al. J Cardiothorac Surg. .

Abstract

Background: Iatrogenic complications of endovascular treatment for central venous stenosis have not yet been reported. Here we present a case of a patient on maintenance hemodialysis who developed catheter-related superior vena cava syndrome and subsequently suffered from hemorrhagic pericardial tamponade after undergoing percutaneous transluminal angioplasty and stenting.

Case presentation: A 72-year-old male patient presented with uremia, and had been receiving maintenance hemodialysis for the past five years. The patient initially presented with dysfunction of the dialysis catheter (a cuffed tunneled double-lumen catheter in the right internal jugular vein). Imaging examination revealed a segmental occlusion of the superior vena cava stretching from the distal end of the dialysis catheter up to right atrium entrance, apparent compensatory dilatation of the azygos vein, and abundant subcutaneous collaterals. The patient underwent percutaneous transluminal balloon dilatation and stenting (covered stent) of the superior vena cava in the Cath Lab. During the procedure, with forceful advancement of the guidewire, it was observed to progress for a distance before a "smoke" appeared, and an outward spillage of contrast agent was visible, which suggested a possible vessel puncture leading into the mediastinum. Unfortunately, postoperative hemorrhagic pericardial tamponade occurred and the patient developed cardiogenic shock. He experienced symptoms included chest tightness and breath shortness with a recorded blood pressure of 84/60mmHg. After draining 600 ml of bloody fluid through pericardiocentesis, the patient's symptoms alleviated and his condition improved.

Conclusions: The case emphasizes the need for increased attention to iatrogenic endovascular injuries during catheter placement and endovascular treatment, such as causing pericardial hemorrhage leading to cardiac tamponade.

Keywords: Case report; Iatrogenic endovascular injuries; Percutaneous transluminal angioplasty; Percutaneous venous stenting; Superior vena cava syndrome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Venography. Venography revealed nearly complete occlusion of the distal end of the catheter in the superior vena cava (SVC). (Arrow: azygos vein; triangle: SVC)
Fig. 2
Fig. 2
Blood flow restoration after intervention. Venography conducted through the catheter demonstrated restoration of blood flow in the SVC
Fig. 3
Fig. 3
Postoperative chest CT examination. Chest CT examination revealed the presence of pericardial effusion (star)
See this image and copyright information in PMC

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