Unusual Gastric Contrast Extravasation After Coronary Angiography

J INVASIVE CARDIOL 2021;33(6):E489. 

Key words: complications, contrast extravasation, coronary angiography, heart failure

A 79-year-old woman presented with new-onset heart failure. She had pleural effusion, pericardial effusion, and an ejection fraction of 35% on echocardiogram. Her coronary angiogram revealed mild coronary artery disease (CAD). However, initially unexplained extravasation of the contrast was also seen in the cranial view during angiogram (Figures 1A and 1B). The decision was made to medically manage CAD, but she remained tachycardic, with borderline low blood pressure. A few hours later, she was taken back to the lab for pericardiocentesis, which drained only 20 mL of clear fluid. High-resolution fluoroscopic images showed an unusual and unexplained appearance of the contrast again, possibly in a subdiaphragmatic location (Figure 1C). She then developed melena. Computed tomography (CT) of the chest and abdomen with intravenous contrast confirmed the extravasated contrast concentrated in the stomach (Figures 1D and 1E). Endoscopy also showed the Cameron erosions in the hiatal hernia and “coffee ground” material in the stomach. Follow-up CT with contrast following stabilization of the patient confirmed the clearance of contrast from the stomach. This represents an unusual case in which fluoroscopy revealed active gastric bleeding with contrast extravasation during coronary angiography. 

From the Division of Cardiology, Ascension Borgess Hospital/Michigan State University, Kalamazoo, Michigan.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted January 18, 2021.

The authors report that patient consent was provided for publication of the images used herein.

Address for correspondence: Mandeep S. Randhawa, MD, Fellow Structural Cardiology, Clinical Assistant Professor, Ascension Borgess Hospital/Michigan State University, 1717 Shaffer Street, Kalamazoo, MI 49048. Email: mandeep_singhrandhawa@yahoo.co.in