CTICasesHemopericardium and Tamponade after Transcatheter Aortic Valve Replacement (TAVR)
Imaging findings
Abdomen and pelvis CT performed shortly after a transcatheter aortic valve replacement (TAVR) shows a large, extremely high-attenuation pericardial effusion (exceeding 170 Hounsfield units) compressing the right heart. The extremely high density is due to contrast extravasation into the pericardial space. Non-contrast CT also shows persistent contrast in the renal parenchyma and cardiac chambers, reflecting severely delayed renal clearance and low cardiac output.
Key takeaways
Hemopericardium is a serious, potentially fatal complication of TAVR that can occur secondary to ventricular perforation by a guide wire or catheter, or annular rupture. The finding of contrast-retaining, high-attenuation blood in the pericardial space indicates active extravasation or procedural contrast accumulation, and emergency surgical evacuation is required.
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