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A 59 year old man underwent quadruple coronary artery bypass grafting in 1989. Ten years later he was admitted to hospital as an emergency with a two week history of increased abdominal swelling, lethargy, breathlessness and ankle swelling. Examination revealed a sinus tachycardia, raised jugular venous pressure, pronounced abdominal ascites, and pitting oedema of the ankles. He was normotensive with normal heart sounds and no significant murmurs. His lung fields were clear. Transthoracic echocardiography revealed moderate left ventricular systolic impairment and localised right ventricular tamponade. Computed tomography confirmed significant compression of the right ventricle by a pericardial mass which contained some central calcification. No communication with the cardiac chambers or extrinsic structures could be identified. At surgery the mass was successfully excised. Histological analysis revealed an organised, partly calcified haematoma. Cardiac tamponade after surgery most often occurs within the first postoperative week or two and generally presents acutely with haemodynamic compromise. Intrapericardial organised haematoma, causing localised compression of the cardiac chambers late after open heart surgery, is unusual.
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