Cardiology Image quiz : A diagnosis no one wants to make !

  What is the lesion? It looks like an  Intracardiac tumor, a myxoma ? a variant of HCM ?  Is it a hydatid cyst, ?  No it’s not. I can give one clue. This is a man-made condition. Oh ok, did this happen inside the cath lab ? Yes, you got it, right. But need a diagnosis. Can you give me one more clue? This patient was undergoing PCI for chronic total occlusion. So, it must be a complication. Then I need to know the list of complications during CTO PCI. Yes, but you may not find this one in the conventional list. Let me come out with the answer. Answer It is a huge septal hematoma due rupture of vulnerable septal collateral during retrograde wiring for opening LAD CTO.It usually occurs due to o prolonged procedures and hardware-related injury. Thanks to the authors from Taiwan to post this case report. (Image Courtesy Lin & Wu 2005 Ref 1) Lessons from this case report (Not meant to offend anyone ) This case gives us some important lessons to be learned. One of my senior colleagues used to say, opening a CTO is ok, but using a retrograde approach with aggressive deploying of hardware within the last remaining lifeline provided by the donor coronary artery is a culpable coronary crime unless it is a life-saving procedure. The often used term “septal surfing” adds an “adventure sport feel” to our youngsters posing as an interventional challenge ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized Source Type: blogs