Conservatively treated intramyocardial dissecting haematoma of the interventricular septum as a rare complication of acute myocardial infarction: a case report

Figures

• 

  Figure 1. ST-elevation of 3 mm and formed Q-waves in the anterior and lateral wall leads.

• 

  Figure 2. (A) The proximal segment of the left anterior descending artery was occluded. (B) Two drug-eluting stents were implanted. TIMI 3 flow was achieved, without visible signs of complications.

• 

  Figure 3. (A) Transthoracic echocardiography; (B) coronary computed tomography angiography; (C) native computed tomography scan, axial view; (D) coronary computed tomography angiography, four-chamber view. (A) Transthoracic echocardiography revealed a spindle-shaped mass in the hypokinetic/akinetic interventricular septum, with a central echo-lucency; (B) coronary computed tomography angiography revealed significant narrowing of the left anterior descending artery distal to the applied stents due to spasm; (C) spindle-shaped mass in the interventricular septum, hyperdense on native computed tomography; (D) without enhancement on post-contrast computed tomography.

• 

  Figure 4. (A) Cine bright blood sequence, short-axis view; (B) Cine bright blood sequence, four-chamber view; (C) T2-weighted black blood triple inversion recovery sequence, short-axis view; (D) T1-weighted black blood double inversion recovery LGE sequence, short-axis view. On all sequences, we can see intraseptal mass that has hypointense signal to the myocardium. (D) There is no LGE of mass. LGE around mass is present in anteroseptal wall.

• 

  Figure 5. (A) Cine bright blood sequence, short-axis view; (B) Cine bright blood sequence, four-chamber view; (C) T2-weighted black blood double inversion recovery sequence, short-axis view; (D) T1-weighted black blood double inversion recovery sequence, short-axis view. After 2 weeks, haematoma is showing decrease in size on all sequences and hyperintense signal to the myocardium due to methaemoglobin.

• 

  Figure 6. (A) Cine bright blood sequence, short-axis view; (B) Cine bright blood sequence, four-chamber view; (C) T2-weighted black blood triple inversion recovery sequence, short-axis view; (D) resting first pass perfusion imaging, short-axis view; (E) T1-weighted LGE sequence, short-axis view; (F) T1-weighted LGE sequence, four-chamber view; (G) T1-weighted LGE sequence, three-chamber view; (H) T2*-weighted sequence, short-axis view; (I) coronary computed tomography angiography. After 2 months: (A and B) significant decreasing of haematoma in size; (C and H) haematoma has hypointense signal to the myocardium due to haemosiderin; (D) haematoma is showing reduced signal intensity on resting first pass perfusion imaging; (E–G) transmural LGE of anteroseptal wall, in left anterior descending artery territory; (I) significant stenosis is not visible in this image, as it was in Figure 2B.