Superior Vena Cava Syndrome due to pericardial hematoma: A case report and mini-review of literature

Abstract

Superior vena cava syndrome is a life-threatening condition. Typically, the clinical presentations are gradual; hence, the diagnosis is often delayed until critical compression or obstruction has occurred. Pericardial hematoma is a rare condition that could occur after cardiac surgery. An asymptomatic, 25-year-old female, who underwent surgical atrial septal defect closure 5 days ago, was sent for routine echocardiography examination before discharge. An intrapericardiac hematoma was detected at the right atrium’s free wall without any intracardiac hemodynamic consequences. The patient was discharged and planned for monthly evaluation. During follow-up, the intrapericardiac hematoma was expanding. In the third month’s follow-up, the patient complained of shortness of breath, headaches, and coughs. Echocardiography evaluation revealed enlarged pericardial hematoma, which compressed the right atrium and superior vena cava orifice, without echo’ sign of cardiac tamponade. Computed tomography scan revealed superior vena cava compression by the pericardial hematoma and appearance of the collateral vessel. The patient was diagnosed with superior vena cava syndrome and sent for surgical evacuation. Pericardial hematoma after cardiac surgery should be evaluated meticulously. Chronic expanding hematoma could cause superior vena cava syndrome, which is fatal. Early diagnosis and appropriate treatment are essential in managing this condition.

Superior Vena Cava Syndrome Due to Right Anterior Mediastinal Hematoma: A Case Report

“…Mediastinal hematoma caused due to damage from epicardial wires of CABG is an uncommon but significant complication [4,5]. Mediastinal hematoma with sufficient volume may result in compression of the neighboring heart chambers or vessels, one of which could be superior vena cava leading to the superior vena cava syndrome [5].…”

“…The computed tomography angiography (CTA) chest revealed a hematoma with an active extravasation within the right superior anterior mediastinum measuring 6 x 8 x 4 cm, outside the pericardium, and helped rule out hemopericardium. The imaging, just like in Figure 1, also showed that the posteriorly superior vena cava was compressed [4,5]. Due to the presence of hemorrhage adjuvant to epicardial pacer leads, it was proposed as a possible etiology for hemorrhage.…”

“…Source: Saboe et al [4] SVC: superior vena cava CT brain showed no abnormality. An echocardiogram showed an ejection fraction of 60% and confirmed the absence of hemopericardium.…”

“…These symptoms can be gradually progressing and are very often missed [2]. The superior vena cava syndrome is also known to cause sudden death [3,4].…”

Right Heart Failure as an Atypical Presentation of Chronic Type A Aortic Dissection - Multimodality Imaging for Accurate Diagnosis and Treatment. A case report and mini-review of literature

“…The differential diagnosis of a pericardial mass is challenging, and both benign and malignant (primary or metastatic) diseases should be considered [31]. Heterogenous non-neoplastic pericardial entities (hematomas, thrombi, pseudoaneurysms, cysts, and inflammatory pseudo tumours) are described in the literature [32], as is the contribution of multimodality imaging in the diagnosis of multiple pericardial hematomas and the development of progressive superior vena cava syndrome [33,34]. However, the literature to date has not described the presence of a pericardial haematoma secondary to chronic TAAD compressing the right atrium and the superior and inferior caval veins, leading to right heart failure.…”