Pulmonary artery compression by a localized epicardial hematoma in a patient with idiopathic thrombocytopenic purpura after percutaneous coronary intervention: a case report

BACKGROUND: The most common complication of coronary artery perforation, a rare complication of percutaneous coronary intervention (PCI), is hemopericardium with cardiac tamponade. However, localized extra-coronary bleeding can lead to epicardial hematoma, which is a rare phenomenon. We report the case of an unusual delayed presentation of post-PCI hematoma with unrecognized guidewire perforation. CASE PRESENTATION: A 70-year-old man with idiopathic thrombocytopenic purpura (ITP) and a history of coronary artery bypass grafting (CABG) underwent PCI. A bare metal stent was implanted in left main coronary artery (LMCA) after balloon dilation. The procedure was performed without any complications, and the patient was discharged 5 days later. However, the patient was unexpectedly admitted by ambulance with cardiogenic shock and new-onset chest pain the next day. Echocardiography did not show any wall motion abnormalities, but a large mass on the right ventricle outflow tract was detected. Contrast-enhanced computed tomography showed a hematoma compressing the main pulmonary artery trunk and the right ventricle. The patient developed sudden cardiopulmonary arrest and cardiopulmonary resuscitation was successful. The patient died during emergent surgical removal of the hematoma. Large, dark red clots between the pulmonary artery trunk and aorta were observed. The suspected origin of the epicardial hematoma was blood oozing from the stent site in LMCA. CONCLUSION: This is an unusual case with delayed development of localized hematoma following PCI in the absence of guidewire perforation. Furthermore, this case illustrated the potential of occasional critical complications in patients with impaired blood clotting undergoing PCI.