Key result
Multimodality imaging effectively aids diagnosis of rare, life-threatening intramural hematoma.
Why the study?
Intramyocardial dissecting hematoma is a rare and potentially life-threatening complication of percutaneous coronary intervention that requires accurate diagnosis and management.
Case Report (n=1)
Multimodality imaging is crucial for diagnosing and guiding the management of intramyocardial dissecting hematoma, a rare and life-threatening complication of PCI.
Supports multimodality imaging for suspected cases; leaves open need for prospective validation before practice change.
BACKGROUND: Intramyocardial dissecting hematoma is a rare complication of percutaneous coronary intervention. CASE SUMMARY: A 56-year-old patient underwent percutaneous coronary intervention with successful right coronary artery stenting, complicated by distal wire perforation and contrast extravasation. Although initially managed conservatively, follow-up echocardiography showed a rapidly expanding septal intramyocardial hematoma. Urgent coronary angiography demonstrated multiple sites of contrast accumulation, which progressed despite balloon inflation, but ultimately stabilized after covered stent placement. Cardiovascular magnetic resonance and computed tomography angiography confirmed the diagnosis of intramyocardial hematoma and revealed transmural myocardial infarction with microvascular obstruction. DISCUSSION: Most reports describe intramyocardial hematomas in chronic total occlusion or prior bypass surgery. In this case, multimodality imaging suggests subclinical myocardial infarction with spontaneous reperfusion, creating a vulnerable environment for rapid hematoma expansion. Covered stent placement likely prevented septal wall rupture. TAKE-HOME MESSAGE: Multimodality imaging facilitates diagnosing intramural hematoma, a rare but potentially life-threatening complication.
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Cauteren et al. (2026) conducted a case report in Intramyocardial dissecting hematoma (n=1). Multimodality imaging was evaluated. In a 56-year-old patient, multimodality imaging facilitated the diagnosis of a rare, life-threatening intramyocardial dissecting hematoma following PCI, which was stabilized by covered stenting.
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