Patients with Haemopericardium

Would you drain a haemopericardium secondary to AAD (Fig 1)?

Fig 1: Transthoracic echo subcostal view

 

 

No. In patients with haemopericardium it is imperative that pericardiocentesis is not performed as a number of case series have demonstrated that rapid decompression of the pericardium can restart fresh bleeding with rapidly fatal consequences [6].

It is thought that the pressure gradient between the false lumen and the pericardial sac is suddenly increased when pericardiocentesis is performed thereby causing sudden and catastrophic bleeding into the pericardial sac.

As a result of several case reports highlighting this problem, the recommendations of the Task Force on Aortic Dissection also discourage pericardiocentesis in this context [7].