Intramyocardial Dissecting Hematoma: An Unusual Form of Subacute Cardiac Rupture

Abstract

Intramyocardial dissecting hematoma following myocardial infarction is an unusual form of subacute cardiac rupture that tends to develop along naturally occurring dissection planes between the spiral muscles of the ventricle. The diagnosis has commonly been made at surgery, postmortem examination, or by echocardiography. Most are associated with acute transmural inferior infarction. Few patients survive without surgical intervention. Fourteen cases have appeared in the literature. One additional case is described. Ten cases were treated medically with one survivor (10%). Five cases were treated surgically with five survivors. Surgical treatment of intramyocardial dissecting hematoma is preferable to medical treatment. Proper and timely diagnosis and prompt surgical treatment are necessary before complete myocardial rupture ensues. Diagnosis is facilitated through the use of two-dimensional echocardiography. Successful surgical management of this condition requires an appreciation of commonly associated pathoanatomical conditions, and the utilization of appropriate methods of repair in the presence of potential ventricular septal and ventricular free wall rupture.

Giant Intramyocardial Dissecting Hematoma: A Rare Sequela of Subacute Myocardial Infarction

“…In addition, computed tomography of the chest and cardiac magnetic resonance imaging can have diagnostic roles in revealing intact myocardium around an intramyocardial cavity. 2,3 In our patient, we first identified intramyocardial hematoma by echocardiography and confirmed that diagnosis by means of computed tomography. …”

Interventricular septum hematoma is rare complication of congenital heart disease surgery

“…Между тем у взрослых формирование гематомы МЖП описано после инфарктов миокарда (ИМ) [2,10], операций хирургиче-ской и чрескожной реваскуляризации миокарда [4], есть наблюдения посттравматической гематомы МЖП [11,12].…”

Chronic postinfarction pseudo‐pseudoaneurysm diagnosed by cardiac MRI

“…This entity can develop after blunt chest trauma (4), but is usually the consequence of acute myocardial infarction. The chance of survival is thought to be low if corrective surgery is not performed (3). On the other hand, in some cases a spontaneous resolution of the pseudo-pseudoaneurysm was also detected (5)(6)(7)(8).…”

“…It is extremely rare that an incomplete rupture of the infarcted left ventricular wall is reported. In this condition-which is termed intramyocardial dissecting hematoma or pseudo-pseudoaneurysm-the rupture of the myocardium remains circumscribed within the ventricular wall itself, freely communicating with the left ventricular cavity (2,3). This entity can develop after blunt chest trauma (4), but is usually the consequence of acute myocardial infarction.…”