Clinical Report: Unusual Presentation of a Large Hematoma in the Right Ventricular Wall

Background

Coronary artery perforation (CAP) is a serious complication of PCI, occurring in 0.1%–0.8% of cases, with type III perforations posing the highest risk of rapid hemodynamic compromise. Typically, type III perforation results in massive pericardial effusion and cardiac tamponade. However, postperforation bleeding can be localized beneath the epicardium, forming a subepicardial hematoma with minimal pericardial effusion. This case reports a patient with compressive subepicardial hematoma on the right ventricular wall secondary to an Ellis type III coronary artery perforation who was treated with emergency coronary artery bypass grafting (CABG) and hematoma evacuation.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

• The patient presented with hemodynamic instability mimicking cardiac tamponade.
• Imaging revealed a subepicardial hematoma on the right ventricular surface with minimal pericardial effusion.
• Emergency coronary artery bypass grafting combined with hematoma evacuation was performed successfully.
• Type III coronary artery perforation can lead to localized bleeding beneath the epicardium.
• In-hospital mortality rates for type III perforation range from 19% to 27.2%.

Clinical Implications

Clinicians should recognize atypical presentations of coronary artery perforation, particularly the possibility of subepicardial hematomas.

Conclusion

This case illustrates an atypical presentation of coronary artery perforation during PCI.

Related Resources & Content

1. Frontiers in Cardiovascular Medicine, 2026 -- A Case Report of Iatrogenic Coronarocameral Fistula After Surgical Aortic Valve Replacement: Multimodality Diagnosis and Intravascular Ultrasound-Guided Left Main Intervention
2. Clinical Research in Cardiology, 2009 -- Late Loss of Capture Following Revision of Right Ventricular Pacing Lead: Investigating the Underlying Mechanism
3. Frontiers in Anesthesiology, 2026 -- Case Report: Point-of-care ultrasound-guided rescue of massive haemothorax after percutaneous nephrolithotomy
4. Frontiers in Cardiovascular Medicine, 2026 -- Case Report: Giant coronary artery aneurysm with cardiac compression successfully managed by surgical resection and bypass in a normolipidemic patient
5. Frontiers | A practical approach to the management of percutaneous coronary intervention complications, 2026
6. Clinical Outcomes of Coronary Artery Perforation Treated With Covered Stents: The Impact of Intravascular Ultrasound Guidance in a Contemporary Cohort - PubMed
7. Frontiers | A practical approach to the management of percutaneous coronary intervention complications
8. Clinical Outcomes of Coronary Artery Perforation Treated With Covered Stents: The Impact of Intravascular Ultrasound Guidance in a Contemporary Cohort - PubMed