Intramyocardial Dissecting Hematoma: Cardiac Trauma and Ischemic Heart Disease: Multimodality Imaging Techniques

Background Cardiac blunt trauma clinically presents as a spectrum of injuries of varying severity. However, the diagnosis of complications of remote myocardial trauma is often challenging, especially if the patient forgets to mention a remote history of chest trauma. Case summary Here, we present a patient who recently experienced traumatic myocardial dissection and interventricular septal rupture, alongside three patients exhibiting a mimic double-chambered left ventricle, indicative of prior remote myocardial trauma potentially associated with the myocardial dissecting tear. Discussion Patients with recent severe myocardial injury are detectable through cardiac imaging. However, forgotten remote myocardial trauma can lead to adverse myocardial remodeling, heart failure, and arrhythmias. Long-term myocardial remodeling can obscure initial myocardial imaging characteristics, posing challenges in interpretation. Our case series suggests remote myocardial trauma may be more prevalent than commonly thought in clinical practice.

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Intramyocardial dissecting hematoma: Two case reports and a meta‐analysis of the literature

Leitman

Tyomkin

Sternik

et al. 2018

Echocardiography

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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 original and 38 literature cases) were included. Mean age was 60. In 32 cases, IDH was a complication of myocardial infarction (MI), in 66% anterior, a mean time from symptoms to diagnosis was 9 days. Thirty-eight % underwent surgery. In-hospital mortality was 23%. Multivariate analysis showed that the strongest independent predictor of mortality (42%) was EF < 35%; in patients with age >60, mortality risk was 44%; and in the presence of MI or late diagnosis (>24 hours since symptoms started), mortality risk was 50%. In summary, IDH is a diagnostic challenge. A high level of suspicion is needed for prompt diagnosis. Management of these patients is based on individual clinical and imaging parameters. Low EF, age > 60, and late diagnosis, all are predictors of in-hospital mortality.

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Intramyocardial Dissecting Hematoma: Cardiac Trauma and Ischemic Heart Disease: Multimodality Imaging Techniques

Cited by 3 publications

References 4 publications

Acute Intramyocardial Right Ventricular Hematoma After Coronary Artery Bypass Graft

Acute Intramyocardial Right Ventricular Hematoma After Coronary Artery Bypass Graft

Recent and speculative remote myocardial trauma: a case series

Intramyocardial dissecting hematoma: Two case reports and a meta‐analysis of the literature

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