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Extrapericardial (Mediastinal) Cardiac Tamponade

W. Peter Geis, MD; Charles F. Johnson, MD; Rostik Zajtchuk, MD; C. Frederick Kittle, MD
Arch Surg. 1970;100(3):305-306. doi:10.1001/archsurg.1970.01340210081020.
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Acute cardiac tamponade, secondary to trauma, is a well known entity.1-5 Stab wounds of the heart or intrapericardial great vessels are by far the most common causes. Perforation of the myocardium during insertion of transvenous pacemakers and perforation at cardiac catheterization are less frequently responsible for causing acute cardiac tamponade.3 Recently, two cases of right atrial perforation with tamponade were reported, following insertion of a central venous cannula.6

On rare occasions, acute compression of the extrapericardial mediastinum occurs. These cases present with the symptomatology and clinical findings of acute cardiac tamponade. Al-Naaman has reported such an instance, due to massive mediastinal hemorrhage.7 To our knowledge, there are only two additional cases in medical literature.

No report is available of cardiac tamponade following inadvertent infusion of intravenous fluids into the mediastinum. This paper describes such a case and emphasizes the significance of differentiating extrapericardial from intrapericardial compression.


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