Objective:

To report a rare case of atypical Ellis type III coronary artery perforation leading to a subepicardial hematoma and to discuss its management.

Approach:

Key Findings:

• The patient exhibited hemodynamic instability mimicking cardiac tamponade.
• Imaging revealed a subepicardial hematoma on the right ventricular surface with minimal pericardial effusion.
• The patient was successfully treated with emergency CABG and hematoma evacuation.

Interpretation:

This case presents an atypical presentation of Ellis type III coronary artery perforation and emphasizes the need for timely surgical intervention.

Limitations:

• The case is a single patient report, limiting generalizability to broader populations.
• There is a lack of long-term follow-up data beyond one month.

Conclusion:

This case provides insights into managing atypical presentations of coronary artery perforation during PCI.

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