Ann Thorac Surg 2006;82:1915
© 2006 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Thoracoscopic Removal of Pericardial Foreign Body
Sita Rama Rao Podila, MRCS, FETCS,
Adam Szafranek, MD,
Asif Raza Rathore, MBBS,
Subramaniam Balachandran, MD, FRCA,
Nihal P. Kulatilake, FRCS, FETCS*
Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, University Hospital of Wales, Cardiff, South Wales, United Kingdom
* Address correspondence to Dr Kulatilake, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff CF14 4XW South Wales, United Kingdom. (Email: kulatilakenp{at}cardiff.ac.uk).
A 66-year-old man had an uneventful coronary bypass in November 2004. He presented with an erythematous swelling at the lower end of the sternotomy incision in April 2005. Routine investigations for infection were negative.
A computed tomographic scan (Fig 1) showed a thick-walled, retro sternal collection of fluid compressing the heart and presenting as a subcutaneous collection at the lower end of the sternum.
A clear straw-colored pericardial collection was drained by a subxiphoid incision. In view of the uncommon occurrence, thoracoscopy was done to explore the cause of the chronic collection. A dark, 3 cm x 1 cm solid irregular mass and another smaller piece of same material were noticed lying in the cavity near the inferior wall of the right ventricle. These were removed piecemeal under vision using telescope mounted forceps. These foreign body pieces were confirmed by the Cryolife Company as Bioglue (Cryolife International Inc, Kennesaw, GA) (Fig 3).
A single pericardial drain was left in place and gradually shortened for the next 2 weeks to allow complete healing of the cavity. A repeat computed tomographic scan (Fig 2) performed 4 weeks later showed complete healing of the cavity.
Bioglue (Cryolife International Inc) was used on the inferior wall of the heart during the first time that coronary artery bypass grafting was performed in November 2004. We believe that the residual Bioglue (Cryolife International Inc) acted as a foreign body leading to the current presentation of chronic pericardial collection.
