Occult hemorrhagic shock due to hemomediastinum following PCI: a case report

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ID: 325193
2026
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Abstract
Abstract Background Mediastinal hematoma is a rare complication following percutaneous coronary intervention (PCI) with challenging diagnosis and potential life-threatening consequences. Case summary This report documents the case of an 87-year-old woman who underwent PCI for an in-stent restenosis of the proximal left circumflex artery (LCx). One hour after the procedure, the patient developed signs of shock such as dyspnea, hypotension, and altered mental status. Initial evaluation, including physical examination, electrocardiography (ECG), and transthoracic echocardiography (TTE) was negative. Subsequent computed tomography (CT) angiography revealed a mediastinal hematoma and active bleeding of the right thyrocervical artery. After urgent successful embolization, hemodynamics stabilized, and recovery was uneventful. Discussion This case highlights the importance of considering rare (iatrogenic) bleeding sources as a potential cause of shock after coronary angiography or PCI and its diagnostic pitfalls. Prevention relies on meticulous guidewire manipulation with continuous fluoroscopic visualization while advancing when hydrophilic guidewires are required in challenging anatomies.
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Authors Dimitri Sleeckx, Torab Al Hatawe, Frederic De Roeck
Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag598
URL
https://doi.org/10.1093/ehjcr/ytag598
Keywords Keywords not found

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