Cardiac tamponade by loculated pericardial hematoma following open heart surgery: diagnosis by transesophageal echocardiography.

Loculated pericardial hematoma following open heart surgery may cause significant hemodynamic compromise. Recognition of this entity may be delayed because of the absence of the classical signs of cardiac tamponade. A 54-year-old woman is described in whom transesophageal echocardiography allowed rapid diagnosis of right atrial compression by a pericardial hematoma, following mitral valve replacement. Transesophageal echocardiography should be considered for the detection of posterior loculated pericardial hematoma in the hypotensive cardiac surgical patient with a suboptimal transthoracic echocardiogram.