Cardiovascular magnetic resonance and echocardiographic findings of a large thrombosed intramyocardial dissecting hematoma: a case report and a brief review of literature

Figures

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  Figure 1.. Transthoracic echocardiography: Parasternal long-axis view (a). Apical four-chamber view in systole (b) & diastole (c).Colour Doppler echo (d). Apical parasternal short-axis view (e). Contrast echo (f). LV apical partially thrombosedneocavity (arrows in a, b), the inner boundary of which is made by an endomyocardial layer displaying paradoxical diastolic contraction (c).No detectable communication between the LV cavity and the neocavity neither in the colour Doppler nor the contrast echo images. LV ( left ventricle).

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  Figure 2.. Cardiovascular magnetic resonance: Two-chamber and four-chamber balanced steady-state gradient echo cine CMR (a, b). Axial chest T1W-DIR (c). Axial chest T2W-DIR-FS (d). Two-chamber, four-chamber, and short-axis LGE (e, f & g). Heart 3D-contrast-enhanced MRA. The LV IMDH appears as a large contained partially thrombosed cystic lesion displaying high blood signal intensity in T1W-DIR and T2W-DIR. The cyst is delineated by an endomyocardial layer toward the LV cavity (arrowheads in a, b), and by an enhanced outer myocardial layer toward the epicardial surface (arrows in e, f & g). No detectable contrast leakage into the cyst from the LV cavity in post-contrast MRA (H). 3D( three-dimensional); IMDH ( intramyocardial dissecting hematoma); LGE ( late gadolinium enhancement); MRA (magnetic resonance angiography); IMDH (intramyocardial dissecting hematoma); T1W-DIR ( T1 weighted double inversion recovery); T2W-DIR-FS (T2 weighted double inversion recovery with fat suppression).