Netherlands Heart Journal

, Volume 27, Issue 6, pp 337–337 | Cite as

A 69-year-old male patient presenting with chest pain and shortness of breath

  • Y. SalehEmail author
  • K. Herzallah
  • M. Elsayed
  • S. Elkinany
  • S. Rayamajhi
Open Access
Image Puzzle – Answer


Computed tomography demonstrated a solid soft-tissue density in the right aspect of the pericardium, significantly compressing the right atrium, measuring 9.1 × 7.4 cm in diameter (Fig. 1). Transthoracic echocardiography showed a good systolic function, a well-functioning aortic valve prothesis and a mass compressing the right atrium (Video 1). The patient underwent transoesophageal echocardiography-guided video-assisted thoracoscopic surgery and the pathology revealed that it was a localised haematoma. The haematoma was successfully drained, and the patient’s symptoms resolved afterwards (Video 2).
Fig. 1

Computed tomography finding

Haemopericardium secondary to warfarin can occur in patients presenting with pericarditis, coagulopathy or trauma. However, it is extremely rare to occur spontaneously. Usually it presents as circumferential effusion, unlike our patient who presented with a localised haematoma [1]. Haemopericardium is a well-known complication in the early postoperative phase after heart surgery, but in our patient it presented 35 years after aortic valve replacement.


Conflict of interest

Y. Saleh, K. Herzallah, M. Elsayed, S. Elkinany and S. Rayamajhi declare that they have no competing interests.

Supplementary material

​Transthoracic echocardiogram in modified parasternal short axis view at the level of the great vessels

​Transesophageal echocardiogram showing a mass compressing the right atrium


  1. 1.
    Al-Jundi W, Rubin N. Cardiac tamponade secondary to haemopericardium in a patient on warfarin. Case Reports 2010;2010:bcr0120102606.Google Scholar

Copyright information

© The Author(s) 2019

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  1. 1.Michigan State University Clinical CenterEast LansingUSA

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