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A 85-year-old woman was referred to our hospital with a pulsatile mass in the surgical wound of a previous left thoracotomy (A; Supplementary data online, Video S1). Three months earlier, the patient underwent transcatheter aortic valve implantation via subclavian access with a 26-mm CoreValve prosthesis (Medtronic, Inc., Minneapolis, USA) due to severe aortic stenosis and predicted mortality of 25.3% (according logistic EuroSCORE). The procedure was complicated by cardiac tamponade related to a perforation in the left ventricle apex due to the guidewire, which required urgent thoracotomy and direct myocardial suture using 3/0 monofilament between two layers of Teflon (arrows). At admission, the patient was in good general appearance, afebrile, and haemodynamically stable. Suspecting content post-surgical ventricular pseudoaneurysm, it was performed a portable echocardiography study at emergency room that showed an apical left ventricular akinesia without images of rupture or aneurysms, or significant pericardial effusion (B and C; Supplementary data online, Videos S2 and S3). Subsequently, a contrast-enhanced multislice computed tomography (CMCT) was performed to define the aetiology of the mass. CMCT demonstrated a pericardial fluid collection (asterisks) that fistulized through the intercostal muscles into the subcutaneous tissue, showing no blood density and with no evidence of contrast leakage from cardiac chambers (D, E, and F). With image diagnosis of post-surgical seroma, it was decided to drain. Despite the gross appearance of purulent drainage, microbiological culture was negative and the patient had no fever or leucocytosis in the clinical. Finally, she was discharged with oral antibiotic treatment and outpatient local cure, and had good clinical course.

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