Intramyocardial dissecting haematoma mimicking left ventricular clot, a rare complication of myocardial infarction: a case report.

Published on Jun 1, 2019in European Heart Journal - Case Reports
· DOI :10.1093/EHJCR/YTZ056
Tjen Jhung Lee1
Estimated H-index: 1
(NIH: National Institutes of Health),
Aslannif Roslan2
Estimated H-index: 2
(NIH: National Institutes of Health)
+ 1 AuthorsAzmee Mohd Ghazi3
Estimated H-index: 3
(NIH: National Institutes of Health)
Sources
Abstract
BACKGROUND: Intramyocardial dissecting haematoma is a rare complication of myocardial infarction (MI) associated with high mortality rates. Studies and research of this occurrence are limited largely to isolated case reports or case series. CASE SUMMARY: We report a case of late presenting MI, where on initial echocardiogram had what was thought to be an intraventricular clot. However, upon further evaluation, the patient actually had an intramyocardial haematoma, with the supporting echocardiographic features to distinguish it from typical left ventricular (LV) clot. While this prevented the patient from receiving otherwise unnecessary anticoagulation, this diagnosis also put him at a much higher risk of mortality. Despite exhaustive medical and supportive management, death as consequence of pump failure occurred after 2 weeks. DISCUSSION: This report highlights the features seen on echocardiography which support the diagnosis of an intramyocardial haematoma rather than an LV clot, notably the various acoustic densities, a well visualized myocardial dissecting tear leading into a neocavity filled with blood, and an independent endocardial layer seen above the haematoma. Based on this report, we wish to highlight the importance of differentiating intramyocardial haematomas from intraventricular clots in patients with recent MI.
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: Until recently, diagnosis of intramyocardial dissecting hematoma (IDH) was performed during necropsy or at surgery. During the recent years, echocardiography has permitted clinical suspicion, which usually needed confirmation with magnetic resonance imaging (MRI). In this study, we tried to define clinical and imaging features of IDH and predictors of mortality. We searched the literature for proven cases of IDH and analyzed them together with 2 of our cases. A total of 40 cases of IDH (2 our ...
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Intramyocardial dissecting hematoma (IDH) is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction (MI) or during the remodeling process. It is usually caused by a hemorrhagic dissection through the myocardium.1, 2 It consists of blood infiltration into and through the myocardial wall, which maintains endocardial and epicardial integrity. Formation of IDH may result from rupture of intramyocardial vessels into the interstitial space, decreased tens...
8 CitationsSource
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: Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process. It is usually caused by a haemorrhagic dissection among the spiral myocardial fibres and needs urgent surgical treatment. Here we report the case of a 67-year-old man with indications of a previous infarction, in whom a dissecting intramyocardial haematoma was identified using contrast echocardiography.
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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 an...
27 CitationsSource
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41 CitationsSource
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Cited By1
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Background Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far. Case summary We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echoc...
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