Retroperitoneal Hemorrhage Mimicking Pericardial Effusion on Transthoracic Echocardiogram After Transcatheter Aortic Valve Replacement.

BACKGROUND

Retroperitoneal hemorrhage is a life-threatening condition that can present with abnormal fluid collections anywhere in the thoracic or abdominopelvic cavity.

CASE SUMMARY: We describe the case of a 71-year-old woman who developed retroperitoneal hemorrhage with extension into the left thorax following transcatheter aortic valve replacement for severe aortic stenosis. The patient developed hemorrhagic shock with evidence of active bleeding from the left common femoral artery 5 hours postop. Despite successful endovascular stenting, she remained hemodynamically unstable. Bedside ultrasound showed what appeared to be a large-volume pericardial effusion. Following unsuccessful drain placement, repeat imaging revealed tracking of retroperitoneal blood around the heart.

DISCUSSION: The retroperitoneal space communicates with the thoracic cavity, leaving patients susceptible to fluid accumulation in the thoracic cavity surrounding the heart.

TAKE-HOME MESSAGE: Hemorrhagic shock from retroperitoneal bleeding should always be considered in patients with recent vascular instrumentation, even with apparent pericardial effusion on transthoracic echocardiogram.