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Case Reports
. 2022 Nov 2;4(21):1443-1448.
doi: 10.1016/j.jaccas.2022.07.025.

Intramyocardial Dissecting Hematoma: A Mechanical Complication Needing Surgical Therapy?

Mauro Rossi Prat  1 , Maximiliano de Abreu  1 , Graciela Reyes  2 , Juan Diego Wolcan  3 , Julieta Ximena Saenz  4 , Diego Kyle  1 , Laura Antonietti  1 , Javier Mariani  1 , Carlos Daniel Tajer  1
Affiliations
Case Reports

Intramyocardial Dissecting Hematoma: A Mechanical Complication Needing Surgical Therapy?

Mauro Rossi Prat et al. JACC Case Rep. .

Abstract

Intramyocardial dissecting hematoma is a form of cardiac rupture caused by myocardial infarction, percutaneous coronary intervention, or trauma. It is a cavity between myocardial fibers caused by partial rupture of the ventricular wall. Therapeutic management, including the timing for surgical approach, has not been standardized. We present a case series describing 4 patients. (Level of Difficulty: Intermediate.).

Keywords: CT, computed tomography; IDH, intramyocardial dissecting hematoma; STEMI, ST-segment elevation myocardial infarction; TTE, transthoracic echocardiography; cardiovascular disease; computed tomography; dissection; echocardiography; myocardial ischemia.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Apical 4-Chamber View: Patient 1 Intramyocardial dissection flap is shown delimiting the hematoma. F = flap; H = hematoma.
Figure 2
Figure 2
Macroscopic View of Autopsy Specimen: Patient 1 Intraparietal hematoma is seen. Abbreviations as in Figure 1.
Figure 3
Figure 3
Computed Tomography View: Patient 2 Evidence of intramyocardial dissection flap delineating a neocavity is seen. F = flap; N = neocavity.
Figure 4
Figure 4
Apical 4-Chamber View: Patient 3 Endocardial flap and intramyocardial hematoma are seen. Abbreviations as in Figure 1.
Figure 5
Figure 5
Computed Tomography View: Patient 4 Intramyocardial hematoma with thrombus, and hemopericardium, are seen. T = thrombus; HP = hemopericardium; other abbreviations as in Figure 2.
Figure 6
Figure 6
Microscopic Views of Autopsy Specimens: Patient 4 (A) Hematoxylin and eosin stain, ×10 image shows IDH area. (B) Hematoxylin and eosin stain, ×4 image shows hemorrhage in pericardial adipose tissue compatible with apical microperforation. (C) Hematoxylin and eosin stain, ×4 image shows myocardial microperforation area with signs of hemopericardium. A = adipose tissue; E = endocardium; H = hemorrhage; IDH = intramyocardial dissection; M = myocardium; MP = microperforation; P = pericardium; HP = hemopericardium.
Figure 7
Figure 7
Macroscopic View of Autopsy Specimens: Patient 4 Hemorrhage in the apical pericardial adipose tissue, and area of intramyocardial dissection in the anterior left ventricle wall, are seen. H = hematoma; MP = microperforation.
See this image and copyright information in PMC

References

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