Intramyocardial dissecting hematoma after anterior myocardial infarction in a 36-year-old patient: a rare case report

Figures

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  Figure 1. Admission electrocardiogram demonstrating subacute anterior myocardial infarction. The 12-lead electrocardiogram showed sinus tachycardia with pathological Q waves in leads V2–V4, persistent ST-segment elevation, and T-wave inversion in leads V2–V6, accompanied by left anterior fascicular block. The electrocardiographic findings suggested subacute extensive anterior myocardial infarction.

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  Figure 2. Transthoracic echocardiography demonstrating giant intramyocardial dissecting hematoma. (A) Apical four-chamber view showing a large heterogeneous cystic lesion involving the left ventricular apex (delineated by the yellow dashed line and indicated by the red arrow), measuring approximately 63 × 57 mm. The lesion was located within the myocardial wall and caused marked distortion of the apical geometry. (B) Parasternal long-axis view demonstrating a hypoechoic cavity extending from the interventricular septum toward the left ventricular apex (yellow dashed line and red arrow), consistent with intramyocardial dissection. The lesion was initially considered to represent left ventricular thrombus or other intracardiac masses. Combined with subsequent computed tomography and cardiac magnetic resonance findings, the diagnosis of giant intramyocardial dissecting hematoma was established.

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  Figure 3. Cardiac magnetic resonance imaging confirming giant intramyocardial dissecting hematoma. (A) Cardiac magnetic resonance imaging demonstrated a large intramyocardial lesion involving the interventricular septum and left ventricular apex (red arrow). The lesion exhibited heterogeneous signal intensity and was confined within the myocardial wall. (B) Short-axis view showing a giant cystic lesion at the apical region (red arrow), surrounded by infarcted myocardium. CMR demonstrated a large intramyocardial cystic lesion at the interventricular septum and left ventricular apex, with surrounding akinesia. The lesion showed heterogeneous hyperintensity on T1- and T2-weighted imaging, consistent with subacute hemorrhage. Early gadolinium enhancement (EGE) showed no contrast entry into the lesion, excluding pseudoaneurysm. Late gadolinium enhancement (LGE) revealed transmural hyperenhancement of the adjacent myocardium, while the hematoma itself remained hypointense, with no pericardial leakage. These findings—contained intramyocardial lesion, mixed T1/T2 signal, absent early enhancement, and peripheral LGE—are diagnostic of intramyocardial dissecting hematoma, distinguishing it from left…

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  Figure 4. Coronary angiographic findings and percutaneous coronary intervention. (A) Coronary angiography revealed the mid-LAD with TIMI grade 0 flow in the left anterior oblique (LAO) 30°/cranial 30° projection. (B) Complete occlusion of the mid-LAD with TIMI grade 0 flow and collateral circulation from the left circumflex artery to the distal LAD were observed in the right anterior oblique (RAO) 30°/cranial 30° projection. (C) Successful percutaneous coronary intervention with implantation of drug-eluting stents restored TIMI grade 3 flow in the LAD in the right anterior oblique (RAO) 30°/cranial 30° projection.