CTICasesRight Ventricular Rupture from Cardiopulmonary Resuscitation
Imaging findings
An 83-year-old man with a prior aortic valve replacement on anticoagulation had a witnessed cardiac arrest and was successfully resuscitated. Post-arrest CT showed a mediastinal hematoma and a large volume of high-attenuation pericardial fluid, with a focal defect in the right ventricular free wall near the RV outflow tract and a jet of contrast extravasating from the RV into the pericardial space on a timing-bolus series; there was also low attenuation in the left ventricular myocardium suggestive of a coexisting subendocardial infarct.
Key takeaways
Hemopericardium after CPR should be treated with the same urgency as subarachnoid hemorrhage and prompts a careful search for ventricular rupture, a recognized mechanical complication of chest compressions, even without obvious rib or sternal fractures on CT. A timing-bolus series showing contrast extending from the ventricle directly into the pericardial space is a useful clue, and in this case the presumed underlying myocardial infarction that triggered the arrest was also identified on the same study.
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