A Rare Case of Left Internal Mammary Artery Transection During Pericardiocentesis

Authors

Shaun Abid, Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA. Electronic address: shaun.abid@bpthosp.org.
Anton Stolear, Division of Cardiology, Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA.
Lila Kaminsky, Division of Cardiology, Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA.
Samdish Sethi, Division of Cardiology, Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA.
David Narotsky, Division of Cardiology, Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA.
Chirag Shah, Division of Cardiology, Interventional and Structural Heart Disease, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA.
Matthew Seigerman, Division of Cardiology, Interventional and Structural Heart Disease, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut, USA.

Document Type

Article

Publication Title

JACC. Case reports

Abstract

BACKGROUND: Pericardiocentesis is a common procedure for managing pericardial effusions, but it carries risks for vascular injury, particularly in patients with coagulopathies. CASE SUMMARY: A 72-year-old man with factor V Leiden mutation and sick sinus syndrome (status post pacemaker placement), presented with dizziness, dyspnea, and chest pain. Echocardiography revealed a large pericardial effusion with tamponade physiology, necessitating pericardiocentesis. After drain removal, the patient developed hypotension and bradycardia. Imaging identified active bleeding from a distal branch of the left internal mammary artery (LIMA). Hemostasis was achieved via embolization and microcoil placement. The patient recovered with no reaccumulation of effusion or hematoma. DISCUSSION: This rare case of LIMA injury following pericardiocentesis highlights an underrecognized complication, particularly in patients with coagulation disorders. It underscores the need for vigilant postprocedural monitoring and the role of advanced imaging in diagnosing vascular injuries. TAKE-HOME MESSAGE: LIMA injury is a rare but serious complication of pericardiocentesis, requiring prompt-recognition and intervention.

First Page

104041

DOI

10.1016/j.jaccas.2025.104041

Publication Date

6-25-2025

Recommended Citation

Abid, Shaun; Stolear, Anton; Kaminsky, Lila; Sethi, Samdish; Narotsky, David; Shah, Chirag; and Seigerman, Matthew, "A Rare Case of Left Internal Mammary Artery Transection During Pericardiocentesis" (2025). Cardiology. 126.
https://scholar.bridgeporthospital.org/cardiology/126

Identifier

40579107 (pubmed); 10.1016/j.jaccas.2025.104041 (doi); S2666-0849(25)00822-8 (pii)