Arq Bras Cardiol Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia 5RX89pMWXVqzCPYPrvs53zQ S0066-782X2014002400017 00017 10.5935/abc.20140195 Image Cardiac Tamponade Caused by Compression of Right Cardiac Chamber: a Hidden Enemy Evora Paulo Roberto Barbosa Romano Minna Moreira D. Gali Luis Gustavo Rodrigues Alfredo José Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto São Paulo SP Brazil Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, SP - Brazil Mailing Address: Paulo Roberto Barbosa Evora, Rua Rui Barbosa, 367, apt. 15, Centro. Postal Code 14015-120, Ribeirão Preto, SP – Brazil. E-mail: prbevora@fmrp.usp.br; prbevora@gmail.com 12 2014 103 6 e87 e87 12 08 2014 21 08 2014 21 08 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Heart Valve Prosthesis Implantation Cardiac Tamponade Heart Atria/abnormalities Echocardiography

A 58 year-old male patient submitted to mechanical valve prosthesis implant was hemodynamically stable at the postoperative unit and over time developed progressive cardiovascular collapse, requiring high doses of vasopressor amines. The image illustrates selective external compression of the right cardiac chamber, mainly of the right atrium, which caused an unsuspected cardiac tamponade.

A) All reasoning to explain the cardiovascular collapse was concentrated on cardiogenic shock, as the serial radiographs were not suggestive of cardiac tamponade. B) The diagnosis was established by transthoracic echocardiography, which often does not disclose the diagnosis and makes the transesophageal echocardiogram a mandatory procedure. There is an image suggestive of an intrapericardial collection (arrow) causing right atrial compression. Imagem Tamponamento por Compressão de Câmaras Cardíacas Direitas: Um Inimigo Oculto Evora Paulo Roberto Barbosa Romano Minna Moreira D. Gali Luis Gustavo Rodrigues Alfredo José Correspondência: Paulo Roberto B. Evora, Rua Rui Barbosa, 367, apt. 15, Centro. CEP 14015-120, Ribeirão Preto, SP – Brasil. E-mail: prbevora@fmrp.usp.br; prbevora@gmail.com Implante de Protese de Valva Cardíaca Tamponamento Cardíaco Átrios do Coração/anormalidades Ecocardiografia

A 58 year-old male patient submitted to mechanical valve prosthesis implant was hemodynamically stable at the postoperative unit and over time developed progressive cardiovascular collapse, requiring high doses of vasopressor amines. The image illustrates selective external compression of the right cardiac chamber, mainly of the right atrium, which caused an unsuspected cardiac tamponade.

A) Todo o raciocínio para explicar o colapso cardiovascular foi direcionado para choque cardiogênico, porque as radiografias seriadas não foram sugestivas de tamponamento cardíaco; B) O diagnóstico foi estabelecido por meio de ecocardiografia transtorácica, que muitas vezes não revela o diagnóstico tornando obrigatório o ecocardiograma transesofágico. Há uma imagem sugestiva de uma coleção intrapericárdica (seta) causando compressão do átrio direito.