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A 65 year old man presented with chest discomfort accompanied by ST elevation in leads V1–V5 on an ECG. Coronary angiography revealed severe stenosis in the mid portion of the left anterior descending artery (panel A, arrowhead). During percutaneous coronary intervention, a 0.014 inch guidewire was inserted into the septal perforator branch, leading to persistent extravasation of contrast media (panel B). Prolonged balloon inflation in the septal perforator and a reversal of anticoagulation resulted in a haemostasis with difficulty. Subsequent echocardiography showed a newly developed homogenous bulge proceeding from the septal wall (panels C and D: LA, left atrium; LV, left ventricle), with no accumulation of pericardial fluid. Fortunately, neither haemodynamic deteriorations nor elevations of cardiac enzymes occurred during the clinical course of this unfavourable complication. The huge haematoma in his heart was gradually resorbed and disappeared completely several weeks later.
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