Pericardial Tamponade: a Rare Complication of Sternal Bone Marrow Biopsy
An 80-year-old man was brought to the regional hospital because of unclear abdominal pain, diarrhea and concomitant dehydration. He was admitted with diagnosis of pancreatic irritation and acute enteritis. Later, on the basis of laboratory examination of anemia (Ery 3.77×1012L, Hb 112 g/L, Hct 0.35) and thrombocytopenia (72×109L), sternal bone marrow aspiration biopsy was performed. Approximately 45 minutes after the procedure the patient was complaining about general weakness and backache. Echocardiography examination showed pericardial effusion. Later, computer tomography scan excluded suspected ascending aortic dissection. Because of slowly ongoing hemodynamic stability deterioration, the patient was transported to cardiac surgical facility. Transoesophageal echocardiography confirmed pericardial tamponade with right atrium and ventricle compression and dyskinesis (Figure 1A). Immediate surgery was indicated.\nBefore surgical field draping off, puncture site on sternum was clearly visible (Figure 1B). After midline sternotomy, blood effusion in upper mediastinal tissue was found. When pericardial sac was opened, approximately 300 mL of blood were evacuated and hemodynamic stability was immediately achieved. Stab injury was found on the ascending aorta (Figure 1C). This location was sutured with pericardial pledgets. During postoperative course rehydration and short-time full parenteral nutrition was necessary. Overall state of health gradually improved and the patient was transferred back to regional hospital on 7th post-operative day for further rehabilitation.