Outside the box: extra-pericardial tamponade due to acute recurrence of hiatus hernia.

Cardiac tamponade is defined as a life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, thrombus or gas as a result of effusion, trauma, or myocardial rupture. We describe the case of a lady who developed classic signs of cardiac tamponade immediately after an open hiatus hernia repair. Computed tomographic imaging revealed extrapericardial hernia recurrence causing cardiac compression. We believe this is the first such reported case. We conclude that cardiac tamponade from acute recurrence of hiatus hernia must be considered in the unstable postoperative patient and that the definition of cardiac tamponade is expanded to include extrapericardial pathologies. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.