Interventional Radiologist Shanghai General Hospital Shanghai, Shanghai, China (People's Republic)
Background: A rare complication of Budd-Chiari syndrome in conjunction with pulmonary embolism following pulmonary artery catheterization.
Aims: To decrease the risk for serious complications in interventional radiology procedures.
Methods: A 63-year-old male was presented with hemoptysis. Chest CT showed pulmonary embolism, and his D-dimer level was 6 mg/L at that time. Shortly afterwards, percutaneous venography revealed IVC stenosis and outflow obstruction (Fig.1), so Budd-Chiari syndrome was diagnosed. While during selective pulmonary arteriography, a 5-French pigtail catheter was advanced into the pericardiac cavity accidentally. After removal of the catheter, DSA image showed contrast retention in the pericardium (Fig.2). This patient was sweating profusely and his blood pressure couldn’t be measured with 120 beats/min heart rate.
Results: As acute cardiac tamponade occurred, emergency pericardial drainage was undergone immediately, soon thereafter 300ml incoagulable blood were extracted under ultrasound guidance. Hemodynamic parameters of this patient return to normal with symptomatic and supportive treatment. No hydropericardium was detected by follow-up ultrasound. His D-dimer decreased to 0.5 mg/L after oral warfarin therapy.
Conclusion(s): At first, notice disturbance of electrocardiographic artifacts in interventional cardiothoracic procedure at any time. Secondly, together with jugular venous access could be useful in reducing the risk of severe complications under complicated pathophysiology conditions.
