Key result
CMR identifies an intramyocardial dissecting hematoma mimicking a thrombus to guide subsequent OHT.
Why the study?
Intramyocardial dissection is a rare mechanical complication of myocardial infarction that may mimic left ventricular thrombus.
Case Report (n=1)
Multimodality imaging, particularly cardiac magnetic resonance, is critical for distinguishing rare mechanical complications like intramyocardial dissection from left ventricular thrombus to guide appropriate advanced heart failure management.
CMR distinguishes intramyocardial dissection from presumed LV thrombus post-MI; extends diagnostic precision but leaves open prospective validation.
BACKGROUND: Intramyocardial dissection is a rare mechanical complication of myocardial infarction that may mimic left ventricular (LV) thrombus. CASE SUMMARY: A 47-year-old man presented with progressive dyspnea and severe LV dysfunction with a large LV mass initially presumed to be thrombus. Despite anticoagulation, he developed cardiogenic shock and ventricular tachycardia. Coronary angiography showed severe multivessel coronary artery disease. Cardiac magnetic resonance imaging demonstrated extensive anterior transmural infarction with a dissecting intramyocardial cavity consistent with intramyocardial dissection. Given profound LV dysfunction and hostile apical anatomy precluding LV assist device placement, he required temporary mechanical support and underwent successful orthotopic heart transplantation. DISCUSSION: Multimodality imaging is essential to distinguish intramyocardial dissection from thrombus and guide advanced heart failure therapy. TAKE-HOME MESSAGES: Consider intramyocardial dissection in post-myocardial infarction LV masses with clinical deterioration. Cardiac magnetic resonance imaging is critical for diagnosis and management.
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Borg et al. (2026) conducted a case report in Intramyocardial dissecting hematoma after myocardial infarction (n=1). Multimodality imaging (Cardiac magnetic resonance imaging) was evaluated on Diagnosis and management of intramyocardial dissection. Cardiac magnetic resonance imaging successfully diagnosed an intramyocardial dissecting hematoma mimicking a thrombus in a 47-year-old man, guiding subsequent orthotopic heart transplantation.
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