Pericardiocentesis complicated by catheter migration into the pulmonary artery: A case report

Pericardiocentesis is widely used for the management of malignant pericardial effusion and is generally considered a safe procedure; however, when complications occur, they may be sudden and fatal. We describe a 72-year-old woman with metastatic squamous cell lung carcinoma who presented with chest pain, progressive dyspnea, and palpitations. Electrocardiography revealed atrial fibrillation with low-voltage QRS complexes, and transthoracic echocardiography demonstrated a large circumferential pericardial effusion. As the patient developed worsening hypotension and clinical features of evolving cardiac tamponade, apical pericardiocentesis was performed, draining 350 mL of hemorrhagic, non-clotted fluid. Shortly after the procedure, imaging revealed malposition of the drainage catheter, initially within the right ventricle, with subsequent migration into the pulmonary artery. Urgent surgical exploration confirmed right ventricular perforation by the catheter in the presence of dense pericardial adhesions. Despite attempted catheter removal and creation of a pericardial window, the patient died intraoperatively from uncontrollable bleeding. This case illustrates that in patients with malignant pericardial disease, particularly those with prior pericardial interventions, pericardiocentesis may carry a high risk of catastrophic complications. Careful confirmation of catheter position and early consideration of surgical drainage are critical to improving patient safety in high-risk settings.