What is the interpretation of Hemopericardium?

From the Guidelines

Hemopericardium is a life-threatening condition characterized by the accumulation of blood in the pericardial space, often due to aortic dissection, trauma, or other cardiac complications.

Causes and Interpretation

• Hemopericardium can be caused by various conditions, including aortic dissection, penetrating trauma to the heart and chest, and other cardiac complications such as myocardial infarction or cardiac surgery 1.
• The interpretation of hemopericardium depends on the underlying cause, with aortic dissection being a critical condition that requires immediate operative management 1.
• In the setting of aortic dissection, hemopericardium is a sign of severe disease and is associated with high mortality rates 1.

Diagnosis and Management

• Urgent imaging techniques, such as transthoracic echocardiogram or CT, are indicated in patients with a history of chest trauma and systemic arterial hypotension to diagnose hemopericardium 1.
• Controlled pericardial drainage of very small amounts of the hemopericardium may be considered to temporarily stabilize the patient and maintain blood pressure 1.
• Pericardiocentesis as a bridge to thoracotomy may be considered in cardiac tamponade due to penetrating trauma to the heart and chest 1.
• However, pericardiocentesis for dissection-related hemopericardium has been associated with recurrent pericardial bleeding and associated mortality, and should be performed with caution 1.

Treatment

• The treatment of hemopericardium depends on the underlying cause, with surgical intervention being the primary treatment for aortic dissection and other cardiac complications 1.
• In cases of cardiac tamponade, pericardiocentesis is a class I indication, and systemic antineoplastic treatment, pericardiocentesis, and intrapericardial instillation of cytostatic/sclerosing agents may be considered for malignant pericardial effusions 1.

From the Research

Definition and Diagnosis of Hemopericardium

• Hemopericardium (HP) is defined as the accumulation of blood in the pericardial sack 2.
• The diagnosis of HP is crucial, as it can lead to pericardial tamponade, a life-threatening condition 2, 3.
• Echocardiography is the primary method for evaluating pericardial effusions in a clinical setting, while postmortem imaging computed tomography (PMCT) is valuable for detecting HP and assessing its significance in causing death 2.

Causes and Management of Hemopericardium

• Hemopericardium can result from various causes, including cardiac perforation, trauma, and complications of invasive cardiology procedures 3, 4, 5.
• The management of HP often involves pericardiocentesis, which can be performed using an echo-guided percutaneous strategy 3.
• In some cases, surgical intervention may be necessary to treat underlying conditions or to manage persistent bleeding 3, 5.

Clinical Presentation and Diagnostic Challenges

• Patients with hemopericardium may present with symptoms such as chest pain, dyspnea, and fever 4, 5.
• The diagnosis of HP can be challenging, particularly in cases where the etiology is unclear or the patient has a complex medical history 4, 5.
• Multimodality imaging and laboratory procedures can aid in the diagnosis and treatment of HP 4, 5.

Rare Causes and Complications of Hemopericardium

• Hemopericardium can be a rare complication of direct oral anticoagulant therapy, as seen in a case report of a patient taking apixaban 5.
• The use of pericardioscopy can be helpful in diagnosing penetrating cardiac trauma and excluding significant cardiac injury 6.