Complications in Pericardiocentesis: Right Ventricular Perforation in a 75-Year-Old Patient with Lymphoma

BACKGROUND Pericardiocentesis is a commonly used procedure to remove or sample pericardial effusion, and complications of this procedure are rare. This report describes a 75-year-old man with lymphoma and right ventricular perforation during pericardiocentesis for pericardial effusion. CASE REPORT A 75-year-old male patient with diffuse large B cell lymphoma was admitted with concerns of refractory chest tightness and breath shortness after physical exercise. Images from echocardiography showed massive pericardial effusion. After a comprehensive clinical assessment, pericardiocentesis was selected as the corresponding strategy, with the aim to improve the symptom of pericardial compression. However, during the procedure, it was found that the catheter was not placed into the expected location, and the right ventricle was damaged by inappropriate puncture, which led to hemopericardium. Computed tomography showed a high-density 2-mm suspected foreign body penetrating from the pericardial cavity, right ventricle to pulmonary main artery. At the same time, echocardiography showed that cardiac compression was more severe from the progressive effusion and continuous clot formation, which could lead to tamponade or even sudden cardiac arrest. Therefore, this patient immediately underwent emergent exploratory thoracotomy to drain the hemopericardium and remove the misplaced catheter, as well as to repair the damaged right ventricle. CONCLUSIONS Pericardiocentesis has risks due to the invasiveness of the procedure; hence, it is important to conduct complete and comprehensive assessments and preparations before the procedure. Once related complications are found, earlier and effective intervention, including emergent surgery, should be necessary.