Dissecting intramyocardial hematoma presenting as a massive pseudotumor of the right ventricle

Mohan, Jagdish C.; Agarwala, Rajeev; Khanna, S K

doi:10.1016/0002-8703(92)90091-9

Cited by 17 publications

(6 citation statements)

References 4 publications

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“…This entity has also been described to occur spontaneously, after trauma to the chest or after reperfusion procedures. 1,2 It consists of blood infiltration into and through the myocardial wall, which maintains endocardial and epicardial integrity. Formation of an intramyocardial haematoma may result from rupture of intramyocardial vessels into the interstitial space, decreased tensile strength of the infarcted area, and acute increase of coronary capillary perfusion pressure.…”

Section: Introductionmentioning

confidence: 99%

Intramyocardial dissecting haematoma: a rare complication of acute myocardial infarction

Dias

Cabral

Gomes

et al. 2009

European Heart Journal - Cardiovascular Imaging

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Intramyocardial dissecting haematoma (IDH) is a rare complication of myocardial infarction, with very scarce reports in medical literature. Before the advent of non-invasive imaging techniques, the diagnosis of IDH was only made by necropsy. It can develop in the left ventricular free wall, the right ventricle, or the interventricular septum. We present a case of a patient with an IDH after acute anterolateral myocardial infarction, focusing on the utility of echocardiography in the diagnosis and follow-up of this unusual complication. By this imaging modality, it was possible to see the various acoustic densities of the progressive clotting of the intramyocardial haematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers. Based on this report, we believe that serial two-dimensional echocardiography, added, when necessary, by the use of contrast agents is the non-invasive method ideally suited to confirm the diagnosis and monitor its evolution at the patient's bedside.

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Section: Introductionmentioning

confidence: 99%

Intramyocardial dissecting haematoma: a rare complication of acute myocardial infarction

Dias

Cabral

Gomes

et al. 2009

European Heart Journal - Cardiovascular Imaging

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“…It consists of a cystic cavity filled with blood, which is enclosed by sheets of myocardium. [1] Little is known about the optimal management of these patients. Although there is a certain predominance of surgical therapy, conservatively treated cases have also been reported.…”

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confidence: 99%

Rapid retraction of a post-infarction intramyocardial dissecting hematoma

Özpelit

Badak

Özpelit

et al. 2014

Arch Turk Soc Cardiol

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A 60-year-old male with a recent anterior myocardial infarction (MI) was referred to our hospital for implantable cardioverter defibrillator (ICD) implantation. He was on the 42nd day of MI and clinically stable on admission. Electrocardiography showed right bundle branch block with QS pattern on anterior leads. Transthoracic echocardiographic examination revealed an ejection fraction of 25% with akinesis of the apex and mid-apical segments of anterior and septal walls. In the apical-septal region, a pulsatile cavity with systolic expansion surrounded by a thin endomyocardial border was visualized. Color-Doppler interrogation did not demonstrate any flow within that structure. These findings suggested an intramyocardial dissecting hemorrhage formed after MI. Cardiac magnetic resonance imaging also confirmed an intramyocardial hematoma in the mid-apical anteroseptal region. A conservative approach was assumed as the patient was hemodynamically stable. The planned ICD implantation was postponed due to the high risk of perforation. Subsequently, oral anticoagulant therapy with warfarin was initiated against risk of intracardiac thrombus formation. The existing dual antiplatelet therapy was also continued. One week after hospital discharge, he was rehospitalized due to a very high INR of 6.3. The repeated transthoracic echocardiography revealed an almost complete resolution of the intramyocardial dissecting hematoma and adhesion of the surrounding myocardial layers. Oral anticoagulant therapy was discontinued. Echocardiographic examinations showed no change compared to the last examination during hospitalization. This case illustrates a conservatively managed intramyocardial dissecting hematoma case, in which anticoagulant and antiaggregant therapy yielded a rapid retraction without any complication.

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“…Cardiac intramural hematoma is a very rare complication of coronary artery disease or chest blunt trauma 1,2 . Rarely is spontaneous, more often it complicates a coronary procedure, like in the case we are reporting.…”

Section: Discussionmentioning

confidence: 71%