PMC8254154_01
(a) Diagnostic left coronary artery angiogram (right anterior oblique cranial) done through right radial access with Tiger catheter showing mid-segment severe stenosis. (b) Postpercutaneous coronary intervention of left anterior descending with good angiographic result. (c) Diagnostic right coronary artery angiogram (left anterior oblique) showing mid-segment critical stenosis
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F1
A 60-year-old female underwent an uncomplicated PCI to LAD artery [Figure 1a-b] at our institute with two overlapping everolimus-eluting stents (EESs) for acute anteroseptal MI via transradial access with residual disease in RCA [Figure 1c], scheduled for staged PCI. At the end of procedure, check aortogram was performed which ruled out any aortic or RSCA dissection/perforation [Figure 2c, Video 1, and Supplementary Material].
(a) Check left coronary artery angiogram done through right radial access with Tiger catheter. Left anterior descending stent is patent. (b) Final result of transfemoral right coronary artery percutaneous coronary intervention. (c) Check aortogram after percutaneous coronary intervention showing no major dissection or perforation
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F2
For the staged procedure, three weeks later, again via right radial access, check angiogram was done with Tiger II (5 Fr; Terumo Interventional Systems, Somerset, NJ, USA) showing patency of LAD stent [Figure 2a] and ECR 3.5 6F guide catheter was advanced over Terumo exchange 0.035" guidewire across right subclavian artery (RSCA) into the ascending aorta. Two overlapping EES were deployed with good angiographic result [Figure 2b]. At the end of procedure, check aortogram was performed which ruled out any aortic or RSCA dissection/perforation [Figure 2c, Video 1, and Supplementary Material].
(a) Transthoracic echo apical four-chamber view showing hematoma (arrowhead) compressing the left atrium (arrow). (b) Transthoracic echo showing resolution of hematoma (red arrow) behind the left atrium (green arrowhead)
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F3
An urgent bedside echocardiogram revealed no fresh regional wall motion abnormality with an extracardiac mass posterior to the left atrium (LA) [Figure 3a]. Over the next 6 hours, the neck swelling and hoarseness gradually subsided and inotropes were tapered and finally stopped [Figure 3b echo].
(a) Chest X-ray showing upper mediastinal widening with rounded opacity in the right upper lung zone. (b) Progression of chest X-ray opacity involving the entire right lung field. (c) Repeat chest X-ray showing resolving hematoma (arrowhead). (d) Follow-up chest X-ray at 3 months showing complete resolution of hematoma
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F4
A bedside chest X-ray (CXR) showed right superior mediastinal widening and homogenous opacity occupying the right upper lung zone without any mediastinal shift suggestive of a possible hematoma [Figure 4a]. The hematoma progressed and a subsequent CXR revealed opacification of the entire right lung [Figure 4b]. Repeat CXR showed a decrease in mediastinal widening and clearing of lung fields [Figure 4a-c]. A CXR at 3 months follow-up showed complete resolution of hematoma [Figure 4d].
(a) Computed tomography thorax axial section showing posterior mediastinal hematoma (blue star) extending behind the left atrium (red asterisk). (b) Repeat computed tomography showing resolving hematoma in the posterior mediastinum (thick arrow) with no hematoma behind the left atrium (thin arrow)
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F5
The hematoma gradually resorbed in the next 12 hours [Figure 5b]. Repeat CT chest after 4 weeks showed a decrease in size of hematoma [Figure 5b].