Intramyocardial Dissecting Hematoma in Patients with Ischemic Cardiomyopathy: Role of Multimodality Imaging in Three Patients Treated Conservatively

Figures

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  Figure 1. (A) Electrocardiogram at presentation shows biphasic T wave in lead V3, deep T-wave inversion in leads V4, V5, and V6, and Q waves with T-wave inversion in the inferior leads, consistent with angiographic findings. (B) Coronary angiogram shows moderate stenosis at proximal segment of the left anterior descending coronary artery, severe stenosis at midsegment, and complete total occlusion in the distal segment. (C-E) Transthoracic two-dimensional echocardiographic and cardiac magnetic resonance views of IDH. (C,D) At presentation, apical four-chamber view showing dissecting echo-free cavity (arrow). (E) An IDH was confirmed by gadolinium-enhanced magnetic resonance imaging, revealing a large thrombus (arrow) within the apical intramyocardial dissection cavity containing the hematoma in the apical segment.

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  Figure 2. (A) Transthoracic two-dimensional echocardiographic views of intramyocardial dissection (arrow). (B) Transthoracic three-dimensional echocardiography showing a mobile endocardial flap with intramyocardial dissection cavity with spontaneous echocardiographic contrast (arrow). (C) Increased echogenicity over the apex (arrow), consistent with thrombus formation at 3-month follow-up.

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  Figure 3. (A) Thick apical aneurysm (arrow), expanded and compressing the right ventricular chamber with pulsatile systolic expansion and high echo density suggestive of IDH. (B) Subsequent echocardiography 3 months later showing no significant changes compared to previous echo (arrow).