CTICasesRight Ventricular Perforation and Pericardial Contrast Injection
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Imaging findings
Chest radiography shows a newly placed subclavian central venous line positioned deep within the right atrium or right ventricle. CT imaging demonstrates a large volume of contrast medium filling the pericardial space, beautifully outlining the pericardial anatomy including the transverse sinus, superior aortic recesses, pulmonary recesses, and the posterior oblique sinus, rather than distributing normally through the systemic vasculature.
Key takeaways
Central venous catheters positioned deep within the heart can abut the myocardial wall and cause transient perforation during pressurized injection of contrast, leading to iatrogenic intrapericardial contrast administration. Acutely, the instillation of even a small volume of fluid within the non-distensible fibrous pericardium can cause cardiac tamponade, though patients can occasionally remain hemodynamically stable and require only close observation.
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