What radiographic signs suggest a coronary perforation with tamponade?

• A. Pericardial effusion on fluoroscopy or echo
• B. Hemodynamic instability
• C. Contrast extravasation into pericardial space
• D. All of the above

Answer: (D)

When coronary perforation leads to tamponade, evidence appears both on imaging and in the patient’s circulation. A new pericardial effusion seen on fluoroscopy or echocardiography signals that fluid has accumulated in the pericardial sac, a hallmark of potential tamponade. Direct contrast extravasation into the pericardial space provides definitive proof of a perforation. The tamponade physiology then drives hemodynamic instability—hypotension and decreased cardiac output due to impaired filling. Because imaging findings and the clinical/physiologic consequences all point to the same problem, this combination best captures the diagnosis, making all of the above the most accurate choice.