Left Ventricular Perforation and Improper Catheter Placement in Ascending Aorta as a Complication of Emergency Pericardiocentesis

Complications associated with pericardiocentesis can be severe and life-threatening. We report a case of a 25-year-old male presented in the emergency department after a polytrauma. The initial full-body scan showed grade I aortic isthmus injury, hemopericardium at 10-mm depth, grade 3 hepatic lacerations, and grade V spleen laceration complicated by hemoperitoneum. The indication for total splenectomy was emergent. Postprocedural, the patient was hemodynamically unstable and an emergency ultrasound-guided pericardiocentesis was performed to treat the hemopericardium. After draining 500 mL of coagulated blood, rupture of the aortic isthmus with pericardial effusion was suspected. A CT angiography showed an improper catheter placement with left ventricular perforation and the presence of the catheter tip in the ascending aorta. Emergency median sternotomy was performed to remove the catheter and to repair the left ventricle. The patient’s hemodynamic condition improved hours after intervention, and he was discharged 11 days later. Pericardiocentesis should be performed guided by ultrasonography, and even so, it carries risks of complications. Cardiac injury after pericardiocentesis is a rare but serious complication that must be identified quickly and should be treated by a multidisciplinary team.