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European Journal of Echocardiography Advance Access originally published online on March 31, 2009
European Journal of Echocardiography 2009 10(4):585-587; doi:10.1093/ejechocard/jep027
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Intramyocardial dissecting haematoma: a rare complication of acute myocardial infarction

Vasco Dias*, Sofia Cabral, Catarina Gomes, Nuno Antunes, Cristiana Sousa, Miguel Vieira, Ana Meireles, Filomena Oliveira and Severo Torres

Cardiology Department, Santo António General Hospital, Oporto Hospital Center, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal

Received 15 December 2008; accepted after revision 7 March 2009; online publish-ahead-of-print 31 March 2009.

* Corresponding author. Tel: +351 222 077 500; fax: +351 223 320 318. E-mail address: vascoalvesdias{at}hotmail.com


  Abstract

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 and follow-up of this unusual complication.

By this imaging modality, it was possible to see the various acoustic densities of the progressive clotting of the intramyocardial haematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers.

Based on this report, we believe that serial two-dimensional echocardiography, added, when necessary, by the use of contrast agents is the non-invasive method ideally suited to confirm the diagnosis and monitor its evolution at the patient's bedside.

Keywords: Intramyocardial dissecting haematoma; Myocardial infarction; Echocardiography


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