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Case Reports
. 2022 Sep 26;34(2):118-121.
doi: 10.1055/s-0042-1756487. eCollection 2025 Jun.

Acute Mediastinal Bleeding with Pleural Escape: Case Report of a Rare Interventional Complication with Unusual Resolve

Wishnu Aditya Widodo  1 , Arif Mansjoer  2 , Ismail Dilawar  3 , Andri Kurnia  4 , Daniel Ruslim  5
Affiliations
Case Reports

Acute Mediastinal Bleeding with Pleural Escape: Case Report of a Rare Interventional Complication with Unusual Resolve

Wishnu Aditya Widodo et al. Int J Angiol. .

Abstract

Acute mediastinal bleeding is a very rare complication of cardiac intervention. It is a life-threatening situation when this condition causes acute compression of the mediastinal area. A 59-year-old man was diagnosed with inferior ST-elevation myocardial infarction with ongoing chest pain and underwent an urgent percutaneous coronary intervention procedure. After coronary stent was implanted, patient complained of chest tightness, and suffocation, blood pressure dropped, O 2 saturation dropped, and was difficultly intubated. Image acquisition by C-arm showed a large bulging in aortic arch area. Contrast-enhanced computed tomography ruled out aortic dissection, but noted a large mediastinal mass that was radiated to the neck. The bulging was spontaneously regressed, and a large left pleural effusion was developed. Left pleural tapping was performed on day 7, and a total of 1.5-L hemorrhagic fluid was evacuated. In our case, unusual drainage from mediastinal to pleural space has probably save the patient.

Keywords: ST-elevation myocardial infarction; acute mediastinal bleeding; acute mediastinal compression; life-threatening; percutaneous coronary intervention; pleural escape; rare complication.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
(a) Diffuse stenosis lesion of right coronary artery (RCA) with thrombus appearance. (b) Final angiography after percutaneous coronary intervention.
Fig. 2
Fig. 2
(a) Chest X-ray before percutaneous coronary intervention procedure. (b) Image acquisition from C-arm immediately after the patient crashed.
Fig. 3
Fig. 3
(a) Contrast-enhanced computed tomography examination showing slight hyperdensity lesion suggestive of hematoma occupied anterior mediastinal area (blue arrow) with moderate left pleural effusion (orange arrow). (b) Mediastinal collection also seen at upper paratracheal region (blue arrow).
Fig. 4
Fig. 4
(a) Resolution of mediastinal bulging and development of left pleural effusion. (b) Pleural effusion more obvious in erect position.
Fig. 5
Fig. 5
Bruises in neck area were developed on day 7 of hospitalization.
Fig. 6
Fig. 6
(a) Hemorrhagic fluid was evacuated through chest drain from left pleura. (b) Chest X-ray after pleural drain.
See this image and copyright information in PMC

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