Left Ventricular Intramyocardial Dissecting Hematomas

Abstract

Intramyocardial dissection is a rare complication of myocardial infarction, trauma, and percutaneous intervention. It is usually caused by hemorrhagic dissection among the spiral myocardial fibers. We hereby report the case of a patient with left ventricular intramyocardial dissection who presented with acute decompensated heart failure. (Level of Difficulty: Advanced.).

Keywords: EF, ejection fraction; IDH, intramyocardial dissecting hematoma; IHD, ischemic heart disease; IVS, interventricular septum; LV, left ventricle; MI, myocardial infarction; MR, magnetic resonance; NYHA, New York Heart Association; acute heart failure; cardiac magnetic resonance; contrast agent; dissection; myocardial infarction.

Graphical abstract

Figure 1

12-Lead Electrocardiogram Showing Sinus Rhythm With Right Bundle Branch Block and T-Wave Inversion in V₁ to V₆

Figure 2

Parasternal Long-Axis View Showing Intramyocardial Hematoma E = endocardial flap; IMH = intramyocardial hematoma; LA = left atrium; TL = true left-ventricular cavity.

Figure 3

Modified Short-Axis View Showing Multiple Layers of Hematoma Abbreviations as in Figure 2.

Figure 4

Apical 4-Chamber View Showing the Hematoma With Dissected Myocardium M = myocardial flap; other abbreviations as in Figure 2.

Figure 5

Color Doppler in Apical 4-Chamber View Confirming No Flow Into the Neocavity Abbreviations as in Figures 2 and 4.

Figure 6

3-Dimensional Echo Showing the Mobile Endocardial Flap With Intramyocardial Dissecting Hematoma Abbreviations as in Figures 2 and 4.

Figure 7

Contrast Echo Differentiating the True Left Ventricular Cavity From the Neocavity Abbreviations as in Figure 2.

Figure 8

Cardiac Magnetic Resonance Demonstrating Intramyocardial Dissecting Hematoma With Thrombus Abbreviations as in Figure 2.

Figure 9

Late Gadolinium Enhancement Magnetic Resonance Showing the Extensive Myocardial Scar LGE = late gadolinium enhancement; other abbreviations as in Figures 2 and 8.