Author + information
- Received June 23, 2011
- Revision received July 12, 2011
- Accepted July 19, 2011
- Published online April 24, 2012.
- Charoen Mankongpaisarnrung, MD⁎,†,
- Pairoj Chattranukulchai, MD⁎,†,
- Buncha Sunsaneewitayakul, MD†,
- Monravee Tumkosit, MD§,
- Nilubon Methachittiphan, MD⁎,†,
- Seri Singhatanadgige, MD†,‡,
- Smonporn Boonyaratavej, MD⁎,† and
- Sarinya Puwanant, MD⁎,†
A 28-year-old woman with a history of Ebstein's anomaly underwent radiofrequency ablation for supraventricular tachycardia. While the radiofrequency ablation was being performed, she was found to be hypotensive. An echocardiogram revealed no pericardial effusion. However, a huge sessile mass (A1 to A3, asterisks, Online Videos A1, A2, and A3) on the diaphragmatic aspect of the right atrium was detected. Additionally, moderate tricuspid regurgitation (A4, arrow,Online Video A4 and A5) without inflow obstruction was observed. The clinical and echocardiographic contexts favored an intramural hematoma where the ablative catheter injured. The T1- and T2-weighted magnetic resonance imaging showed mild hypersignal intensity on the mass (A6 and A7, asterisks) whereas gadolinium-enhanced imaging (A8, asterisk) showed no delayed enhancement, confirming the diagnosis of hematoma. The patient's course was uneventful with conservative management. An echocardiogram at 11 days and 90 days after the ablation showed a centrifugal lucent appearance (B1 to B3, asterisks, Online Videos B1, B2, and B3) and complete resolution of the hematoma (C1 to C3, Online Videos C1, C2, and C3) respectively.
Right atrial hematoma is rare. This case highlights the utility of multiple noninvasive imaging modalities and underscores a potential dangerous complication of simple radiofrequency ablation. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
- Received June 23, 2011.
- Revision received July 12, 2011.
- Accepted July 19, 2011.
- American College of Cardiology Foundation