Left Ventricular Intramyocardial Dissecting Hematoma: A Multimodality Imaging Diagnostic Approach

Management of Intramyocardial Dissecting Hematoma Following Myocardial Infarction

“…Visually apparent heterogeneous T2 signal with a hypointense signal on late gadolinium-enhanced CMR is suggestive of a thrombus; however, since this thrombus is located within the midmyocardium, sandwiched between the infarcted subendocardium and subepicardium, IDH can be quite easily differentiated from a left ventricular thrombus. 9 In the case of inappropriate anticoagulation therapy due to misdiagnosis as an apical thrombus, there may be progression of the hematoma and bleeding into the pericardial space or LV cavity, which may result in sudden cardiac death. Thus, in our case, only aspirin was administered.…”

Ventricular Intramyocardial Dissecting Hematoma

“… 1 Nevertheless, given the high surgical risk in such cases, both percutaneous and medical approaches have been postulated as feasible and safe second options depending on the type of lesion. 1 , 3 When the IDH presents with entry tear thrombosis, this can seal the cavity and prevent increasing pressure on the damaged wall, reducing the potential risk of rupture and facilitating blood stasis ( Supplemental Figure 2 ). As in our case, early interruption of anticoagulation, combined with adjustment of antiplatelet medication and relative rest, may be a conservative treatment approach that could facilitate complete thrombosis of the lesion.…”

Multimodality Imaging Assessment of Intramyocardial Hematoma

“…4 The prognosis of patients presenting with an intramyocardial hematoma is poor, either with surgical or conservative management. Meanwhile, we have established a treatment strategy for the intramyocardial hematoma, emergency surgery will be performed if there is evidence of intramyocardial hematoma expansion on serial echocardiographic studies, ventricular septal rupture, compromised hemodynamics, or impaired LV systolic function, 2 especially sudden acute myocardial infarction.…”

“…1 It could also result from chest trauma, heart surgery, cine ventriculography examination, and even be spontaneous. 2 Intramyocardial hematoma can develop in the LV-free wall, right ventricular wall, interventricular septum, or left atrial wall. 3 The diagnosis is challenging and requires a high index of clinical suspicion.…”