Presentation
Syncope.
Patient Data
High density pericardial fluid collection indicaties a hemopericardium. There is flattening of the intraventricular septum and contrast reflux into the IVC and hepatic veins with a blood contrast level suggesting tamponade physiology. Type A aortic dissection extending from the noncoronary cusp into the ascending thoracic aorta proximal to the arch.
Case Discussion
Hemopericardium is most often due to rupture of a type A aortic dissection into the pericardium as in this case. Contrast reflux into the IVC and hepatic veins with a blood contrast level indicates that blood cannot return to the right heart because of tamponade physiology. Less common causes of hemopericardium include cardiac rupture and rupture of a coronary artery aneurysm.
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