Cas du 28/03/15: A large clot

Presentation: A patient present to the operating room with this loop.

#1: What is the definition of tamponade?

#2: Does this patient have tamponade?

#3: Is the patient compensating for the left atrial compression?

Explanation:

The definition of cardiac tamponade is the accumulation of fluid/blood/effusion in the pericardial sac that causes decreased filling of the heart.

With the left atrial compression, the left atrium is inhibited from filling so tamponade would be present. However, classically, tamponade, when global, also exhibits collapse of the low pressure areas (atria and right ventricle). In localized tamponade, the affected area is located where the clot or tumor is located. In this patient the left atrium is collapsed. One would expect that the right ventricle and right atrium to be enlarged from decreased filling of the left atrium. They are not enlarged. Also, decreased filling of the left ventricle would exhibit a small ventricular cavity. It is not decreased in size. Therefore, this echo indicates that flow is at least getting through the left atrium to minimally fill the left ventricle.

This clot may be pleural in it's location. A small separation of the left atrial wall and the pericardium can be seen in the video which would indicated that the clot is in the pleural space. While pleural clots causing left atrial compression are rare, it would be consistent with what is seen in the RA, RV, and LV.