Mediastinal thymic hematoma: infrequent complication after transradial cardiac catheterization

Hematoma mediastinal tímico, complicación infrecuente del cateterismo cardiaco por abordaje radial

Vascular complications in cardiac catheterizations are usually infrequent and are directly related to the specific site of vascular puncture. Since the thymic hematoma is so rare, it is not considered a differential diagnosis of chest pain after cardiac catheterization. We present the case of a 62-year-old patient who develops a thymic hematoma after having been taken to a coronary arteriography.

1. Bashore, T. M., Balter, S., Barac, A., Byrne, J. G., Cavendish, J. J., Chambers, C. E., … Tommaso, C. L. (2012). 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions Expert Consensus Document on Cardiac Catheterization Laboratory Standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Journal of the American College of Cardiology, 59(24), 2221–2305. https://doi.org/10.1016/j. jacc.2012.02.010
2. Rao, S. V., Turi, Z. G., Wong, S. C., Brener, S. J., & Stone, G. W. (2013). Radial versus femoral access. Journal of the American College of Cardiology, 62(17 SUPPL), S11–S20. https://doi. org/10.1016/j.jacc.2013.08.700
3. Merkle, J., Hohmann, C., Sabashnikov, A., Wahlers, T., & Wippermann, J. (2017). Central Vascular Complications Following Elective Catheterization Using Transradial Percutaneous Coronary Intervention. Journal of Investigative Medicine High Impact Case Reports, 0–3. https://doi.org/10.1177/2324709617698717
4. Fransson, S. G., & Nylander, E. (1994). Vascular injury following cardiac catheterization, coronary angiography, and coronary angioplasty. Eur Heart J, 15(2), 232–5.
5. Eshaghy, B., Loeb, H. S., Miller, S. E., Scanlon, P. J., Towne,
W. D., & Gunnar, R. M. (1973). Mediastinal Retropharyngeal Hemorrhage. JAMA, 226(4), 427–431.
6. Ng Jao, Y. T. F., Chen, Y., Fang, C. C., & Wang, S. P. (2003). Mediastinal and neck hematoma after cardiac catheterization. Catheterization and Cardiovascular Interventions, 58(4), 467–472. https://doi.org/10.1002/ccd.10476
7. Park, K. W., Chung, J. W., Chang, S. A., Kim, K. Il, Chung, W. Y., & Chae, I. H. (2008). Two cases of mediastinal hematoma after cardiac catheterization: A rare but real complication of the transradial approach. International Journal of Cardiology, 130(3), e89–e92. https://doi.org/10.1016/j.ijcard.2007.05.093
8. Yang, W., Qiao, S., Liu, R., Hu, F., Qin, X., Duo, K., … Yang, Y. (2014). Clinical features and outcome of eight patients with mediastinal and neck hematoma after transradial cardiac catheterization approach. Zhonghua Xin Xue Guan Bing Za Zhi., 42(5), 406–412. https://doi.org/10.3760/cma.j.issn.0253–3758.2014.05.013
9. Habib, N., Jerzewski, A., Koomen, E. M., Groenemeijer, B. E., Waalewijn, R. A., Braam, R. L., … Overtoom, T. T. C. (2012). Subclavian artery perforation complicating coronary angiography. Netherlands Heart Journal, 20(6), 288–290. https://doi. org/10.1007/s12471-011-0164-7
10. Chen, S. C., Wang, C. S., Chuang, S. H., Chen, J. H., Chou, M. C., Chen, H. C., & Chang, J. M. (2009). Mediastinal Hematoma Caused by Central Venous Catheterization: A Rare Cause of Obscure Blood Loss. Kaohsiung Journal of Medical Sciences, 25(8), 460–464. https://doi.org/10.1016/S1607-551X(09)70543-1
11. Gupta, P., Guleria, S., & Sharma, S. (2011). Mediastinal haematoma: a rare complication following insertion of central venous catheter. The Indian Journal of Chest Diseases & Allied Sciences, 53(4), 225–228.
12. Koçak, G., Huddam, B., Azak, A., Yalçin, F., Voyvoda, N., Hidiroglu, M., … Duranay, M. (2012). Internal jugular vein catheterization- induced mediastinal hematoma. Hemodialysis International, 16(2), 326–327. https://doi.org/10.1111/j.1542-4758.2011.00620.x
13. Llàcer-Millán, E., Ramírez, P., Sanmartín, J., Zamarro, J., & Parrilla,
P. (2015). Hematoma cervical y mediastínico por lesión carotídea al canalizar la vena yugular resuelta con un stent. Cirugia Espanola, 93(5), 342–344. https://doi.org/10.1016/j.ciresp.2013.12.015
14. Sarach, J., Zschokke, I., & Melcher, G. A. (2015). A life- threatening mediastinal hematoma after central venous port system implantation. American Journal of Case Reports, 16, 904– 907. https://doi.org/10.12659/AJCR.895486
15. Udy, A., Senthuran, S., & Lipman, J. (2009). Airway obstruction due to a pre-vertebral haematoma following difficult central line insertion - Implications for ultrasound guidance and review of the literature. Anaesthesia and Intensive Care, 37(2), 309–313.
16. Arik, N., Akpolat, T., Demirkan, F., Demirkazik, F., Yasavul, U., Turgan, C., & Caglar, S. (1993). Mediastinal Hematoma : A Rare Complication of Subclavian Catheterization for Hemodialysis. Nephron, 63(3), 354. https://doi.org/DOI: 10.1159/000187223
17. Doyle, B. J., Rihal, C. S., Gastineau, D. A., & Holmes, D. R. (2009). Bleeding, Blood Transfusion, and Increased Mortality After Percutaneous Coronary Intervention. Implications for Contemporary Practice. Journal of the American College of Cardiology, 53(22), 2019–2027. https://doi.org/10.1016/j. jacc.2008.12.073