Catheter Impaction After Pericardial Drainage Due to Inadvertent Entry Into the Transverse Pericardial Sinus.

BACKGROUND

Pericardial drainage is a lifesaving intervention for cardiac tamponade. Difficulty in catheter removal is rare and is typically attributed to thrombus formation or pericardial adhesions.

CASE SUMMARY: A 66-year-old woman developed cardiac tamponade after cryoablation for atrioventricular nodal reentrant tachycardia. Subxiphoid pericardiocentesis was performed without resistance, and a 6-F pigtail catheter was placed under fluoroscopy. Two days later, removal was hindered by marked resistance. Computed tomography revealed inadvertent catheter passage through the transverse pericardial sinus, posterior to the ascending aorta, with lateral reentry into the pericardial cavity, creating a sharply angulated, mechanically anchored course. Saline-induced re-expansion combined with gentle diastolic-phase traction allowed safe removal.

DISCUSSION: The transverse pericardial sinus, a well-known surgical landmark, is a previously under-recognized site of pericardial-drainage catheter impaction.

TAKE-HOME MESSAGE: Smooth catheter insertion does not guarantee correct placement; transverse-sinus malposition should be considered when removal resistance occurs.