A Rare Case of Left Internal Mammary Artery Transection During Pericardiocentesis

TL;DR

A rare case of left internal mammary artery injury after pericardiocentesis is reported in a patient with a coagulation disorder.

Contribution

Highlights LIMA injury as an underrecognized complication of pericardiocentesis in patients with coagulopathies.

Findings

LIMA injury occurred after pericardiocentesis in a patient with factor V Leiden mutation.

Hemostasis was successfully achieved using embolization and microcoil placement.

Postprocedural monitoring and advanced imaging are critical for diagnosing vascular injuries.

Abstract

Pericardiocentesis is a common procedure for managing pericardial effusions, but it carries risks for vascular injury, particularly in patients with coagulopathies.

A 72-year-old man with factor V Leiden mutation and sick sinus syndrome (status post pacemaker placement), presented with dizziness, dyspnea, and chest pain. Echocardiography revealed a large pericardial effusion with tamponade physiology, necessitating pericardiocentesis. After drain removal, the patient developed hypotension and bradycardia. Imaging identified active bleeding from a distal branch of the left internal mammary artery (LIMA). Hemostasis was achieved via embolization and microcoil placement. The patient recovered with no reaccumulation of effusion or hematoma.

This rare case of LIMA injury following pericardiocentesis highlights an underrecognized complication, particularly in patients with coagulation disorders. It underscores the need for vigilant postprocedural monitoring and the role of advanced imaging in diagnosing vascular injuries.

LIMA injury is a rare but serious complication of pericardiocentesis, requiring prompt-recognition and intervention.

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