Intrapericardial Chronic Expanding Hematoma Causing Myocardial Ischemia by Compressing the Left Anterior Descending Artery.

BACKGROUND: Intrapericardial chronic expanding hematoma (CEH) is rare, but the diagnosis is challenging because it should be differentiated from cardiac tumors and can cause unique consequences. CASE SUMMARY: An 80-year-old woman with a history of chest trauma presented with exertional dyspnea. Computed tomography revealed an intrapericardial mass compressing the left ventricle, pulmonary artery, and left anterior descending artery (LAD). Cardiac magnetic resonance and positron emission tomography suggested CEH without malignancy. Coronary angiography showed 99% stenosis of the LAD, but right heart catheterization revealed no hemodynamic compromise in the pulmonary artery and left ventricle. Surgical resection was performed to relieve myocardial ischemia. Histology confirmed the diagnosis of CEH. DISCUSSION: Multimodal testing helped exclude the malignancy and identified myocardial ischemia due to CEH as the primary cause of symptoms. TAKE-HOME MESSAGES: CEH should be considered in patients with prior chest trauma. Multimodality testing is essential for accurate diagnosis and management.