What question did this study set out to answer?

To highlight a rare case of left main intramural coronary hematoma and its implications for management.

March 21, 2026Case Reports in CardiologyOpen Access

The Unseen Culprit: Left Main Intramural Coronary Hematoma

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Key result

Left main coronary intramural hematoma can progress despite conservative management, warranting urgent surgical revascularization.

Population

A 46-year-old woman with left main coronary intramural hematoma

Design

Case report

Authors

MMMario Martínez-FletaHospital Universitario Miguel Servet LCLuis Cerdán-FerreiraHospital Universitario Miguel Servet GFGeorgina Fuertes-FerreHospital Universitario Miguel Servet

Discussion

Member takes

Implication

Prompts readiness for urgent surgical revascularization in proximal coronary intramural hematoma; hypothesis-generating for patient selection in this rare condition.

Key Points

To highlight a rare case of left main intramural coronary hematoma and its implications for management.
Case report of a 46-year-old woman with chest pain and elevated cardiac troponin.
Intravascular ultrasound confirmed coronary intramural hematoma.
Managed conservatively with medications before surgical revascularization due to hematoma progression.
Initial conservative therapy was initiated due to preserved flow and clinical stability.
Coronary imaging revealed progression of the hematoma and severe stenosis by day 13.
Urgent surgical revascularization was performed with a successful recovery.

Structured PICO

Population

1 46-year-old woman with no cardiovascular risk factors presenting with self-limiting chest pain, normal electrocardiography, elevated high-sensitivity cardiac Troponin I, and preserved biventricular function.

Intervention

Initial conservative therapy with aspirin, beta-blocker, and statin, followed by urgent surgical revascularization using bilateral internal mammary artery grafts to the left anterior descending and obtuse marginal arteries on Day 13 due to hematoma progression.

Outcome

Clinical recovery and hematoma progression

Coronary intramural hematoma is a rare cause of ACS where multimodal imaging is essential, and while conservative management is preferred, surgical revascularization is warranted for proximal involvement or ischemic progression.

Cite This Study

Martínez-Fleta et al. (2026) studied this question. Left main coronary intramural hematoma can progress despite initial conservative management, warranting urgent surgical revascularization for proximal involvement or worsening ischemia.

synapsesocial.com/papers/69be38596e48c4981c678bc0 https://doi.org/10.1155/cric/1167942

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Implication

Prompts readiness for urgent surgical revascularization in proximal coronary intramural hematoma; hypothesis-generating for patient selection in this rare condition.

The Unseen Culprit: Left Main Intramural Coronary Hematoma

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

The Unseen Culprit: Left Main Intramural Coronary Hematoma

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider