Coronary Intramural Hematoma in a Young Athlete After Direct Ball Impact to the Chest

Figures

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  Visual Summary. Multimodality Imaging of a Coronary Intramural Hematoma (A) Contrast-enhanced computed tomography showing a proximal left anterior descending artery lesion causing an estimated 25% to 49% stenosis. On the corresponding noncontrast acquisition (red arrow, B), the lesion appears hyperdense, consistent with a coronary intramural hematoma. One-month optical coherence tomography showing a proximal left anterior descending artery mural irregularity consistent with a resolving intramural hematoma (red star, C). The hematoma is located near the origin of the first septal branch and resulted in a basal septal infarction, illustrated by myocardial edema (D), septobasal hypoperfusion (E), and transmural late gadolinium enhancement (F).

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  Figure 1. Electrocardiogram Showing Early Repolarization With Tall T Waves in V3-V4 Coronary angiography demonstrating a nonobstructive lesion of the proximal left anterior descending artery. SSFP = steady-state free precession.

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  Figure 2. Cardiac Magnetic Resonance Findings of Basal Septal Infarction (A) T2 black-blood sequence demonstrating basal septal myocardial edema. (B) T2 mapping sequence confirming basal septal edema. (C and D) First-pass perfusion imaging with corresponding basal septal hypoperfusion. (E and F) Late gadolinium enhancement revealing transmural basal septal enhancement with associated microvascular obstruction.

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  Figure 3. Coronary Computed Tomography Identification of an Intramural Hematoma (A and B) Contrast-enhanced acquisition showing the proximal left anterior descending artery lesion with positive remodeling and an estimated 25% to 49% stenosis. (C and D) Noncontrast acquisition demonstrating spontaneous hyperattenuation of the lesion, confirming the presence of an intramural hematoma (red arrow).

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  Figure 4. Follow-Up OCT and Cardiac Magnetic Resonance Imaging Left: optical coherence tomography performed 1 month after the acute event, demonstrating a focal mural irregularity in the proximal left anterior descending artery, near the ostium of the first septal branch, consistent with a resolving subadventitial intramural hematoma (red star). Right: late gadolinium enhancement sequence on cardiac magnetic resonance at 3 months, showing the localized basal-mid septal infarct sequel.