Journal Information
Vol. 42. Issue 9.
Pages e26-e27 (December 2018)
Vol. 42. Issue 9.
Pages e26-e27 (December 2018)
Images in Intensive Medicine
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Use of echo-contrast in the diagnosis of coronary fistula rupture
Uso de ecocontraste en el diagnóstico de rotura de una fístula coronaria
I. Keituqwa Yáñeza,
Corresponding author

Corresponding author.
, S. Nicolás Francoa, E. Pinar Bermúdezb
a Unidad de Cuidados Intensivos y Electroestimulación Cardiaca, Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain
b Servicio de Cardiología, Sección de Hemodinámica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Seventy-six-year-old male with a prior history of chronic ischemic cardiomyopathy (percutaneous revascularization of left and right anterior descending arteries) and coronary fistula from common trunk to known right atrium who presents to the ER complaining of chest pain and posterior asthenia and progressive dyspnea of one-week duration. During his stay at the ER, the patient develops hypotension and severe desaturation, which is why he is admitted to the ICU where one transthoracic echocardiogram (TTE) procedure is conducted that confirms the presence of massive pericardial effusion of up to 4.3cm (video 1). A pericardial drainage procedure is conducted and the TTE with systemic injection of 3ml of sulfur hexafluoride (Sonovue®) confirms the presence of bubbles from this solution in the pericardium (Fig. 1 and video 2). After stabilizing the patient and on suspicion of coronary fistula rupture, one coronary angiography is conducted that confirms the presence of pseudoaneurysm of the fistula (Fig. 2 and video 3) as the possible cause for the bleeding that is later sealed. The patient was discharged from the hospital after six (6) days.

Figure 1.

Transverse parasternal plane with zoom at posterior wall level.

PE: pericardial effusion; EC: echo-contrast; PW: posterior wall; LV: left ventricle.

Figure 2.

The coronary angiography confirms the presence of pseudoaneurysm (PA) of the coronary fistula.


This case summarizes the utility of echocardiograms in the ICU setting, as well as that of echo-contrast that is also useful in multiple clinical situations.

Appendix A
Supplementary data

The following are the supplementary data to this article:


Subcostal plane. Severe pericardial effusion.


Parasternal plane. Transverse with zoom on the posterior wall showing the presence of echo-contrast in pericardial effusion.


Coronary angiography with presence of pseudoaneurysm of coronary fistula.

Please cite this article as: Keituqwa Yáñez I, Nicolás Franco S, Pinar Bermúdez E. Uso de ecocontraste en el diagnóstico de rotura de una fístula coronaria. Med Intensiva. 2018;42:e26–e27.

Copyright © 2017. Elsevier España, S.L.U. and SEMICYUC
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