A Pressing Matter: Compressive Postoperative Hematoma Causing Acute Diastolic Heart Failure

TY - JOUR

T1 - A Pressing Matter

T2 - Compressive Postoperative Hematoma Causing Acute Diastolic Heart Failure

AU - Winters, Megan

AU - Ezema, Bryan

AU - Ogedegbe, Chinwe

AU - Stoupakis, George

N1 - Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/12

Y1 - 2022/12

N2 - Background: Cardiopulmonary complications in the postoperative period can lead to significant morbidity and mortality. Many of the complications in the postoperative period occur after discharge from the hospital, and up to 25% of patients will require readmission. In postoperative patients presenting to the emergency department (ED), it is important to consider that postoperative complications can affect a multitude of organ systems, including those that are adjacent to where the surgery was performed. Case Report: We present the case of a 54-year-old woman presenting to the ED with shortness of breath in the setting of recent Nissen fundoplication revision. Pulmonary angiography was significant for a large hiatal hernia and negative for pulmonary embolism. She was discharged and returned to the ED a few days later due to worsening symptoms. Further diagnostic studies demonstrated an esophageal hematoma causing compression of the left atrium, leading to acute diastolic heart failure. Why Should an Emergency Physician Be Aware of This?: It is important to consider alternative etiologies for common complaints in the postoperative patient presenting to the ED. Early involvement of the operative team in the patient's care can assist in directing diagnostic approach and management of the postoperative patient.

AB - Background: Cardiopulmonary complications in the postoperative period can lead to significant morbidity and mortality. Many of the complications in the postoperative period occur after discharge from the hospital, and up to 25% of patients will require readmission. In postoperative patients presenting to the emergency department (ED), it is important to consider that postoperative complications can affect a multitude of organ systems, including those that are adjacent to where the surgery was performed. Case Report: We present the case of a 54-year-old woman presenting to the ED with shortness of breath in the setting of recent Nissen fundoplication revision. Pulmonary angiography was significant for a large hiatal hernia and negative for pulmonary embolism. She was discharged and returned to the ED a few days later due to worsening symptoms. Further diagnostic studies demonstrated an esophageal hematoma causing compression of the left atrium, leading to acute diastolic heart failure. Why Should an Emergency Physician Be Aware of This?: It is important to consider alternative etiologies for common complaints in the postoperative patient presenting to the ED. Early involvement of the operative team in the patient's care can assist in directing diagnostic approach and management of the postoperative patient.

KW - cardiology

KW - surgery

KW - ultrasound

UR - https://www.scopus.com/pages/publications/85141535526

U2 - 10.1016/j.jemermed.2022.09.011

DO - 10.1016/j.jemermed.2022.09.011

M3 - Article

C2 - 36369117

SN - 0736-4679

VL - 63

SP - 781

EP - 786

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

IS - 6

ER -