Hsieh Yu-Cheng, Tsai I-Chen, Tsao Chen-Rong, Lin Tung-Chao, Ting Chih-Tai, Wu Tsu-Juey
Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Tex Heart Inst J. 2010;37(3):350-3.
Intramyocardial hematoma is a rare sequela of percutaneous coronary intervention after acute myocardial infarction. Clinical outcomes of intramyocardial hematoma vary from asymptomatic remission to cardiac death. Close follow-up is imperative. Herein, we report the case of a 69-year-old man who had sustained an acute inferior myocardial infarction. During primary percutaneous coronary intervention to the occluded right coronary artery, an intramyocardial hematoma developed and immediately ruptured into the right ventricle. Because the patient remained hemodynamically stable, a conservative approach was taken. Follow-up with serial multidetector computed tomographic imaging elucidated the course and extent of the hematoma and clearly revealed the healing process. After 1 year, this method of imaging showed complete remission of the hematoma. To the best of our knowledge, this is the 1st use of serial multidetector computed tomography to document the remission of an intramyocardial hematoma that ruptured after complicated percutaneous coronary intervention. We believe that multidetector computed tomography is useful in tracing the natural history of intramyocardial hematomas.
心肌内血肿是急性心肌梗死后经皮冠状动脉介入治疗的一种罕见后遗症。心肌内血肿的临床结局从无症状缓解到心源性死亡不等。密切随访至关重要。在此，我们报告一例69岁男性，他发生了急性下壁心肌梗死。在对闭塞的右冠状动脉进行直接经皮冠状动脉介入治疗期间，出现了心肌内血肿并立即破裂入右心室。由于患者血流动力学保持稳定，因此采取了保守治疗方法。通过系列多排螺旋计算机断层扫描成像进行随访，明确了血肿的病程和范围，并清晰显示了愈合过程。1年后，这种成像方法显示血肿完全缓解。据我们所知，这是首次使用系列多排螺旋计算机断层扫描记录复杂经皮冠状动脉介入治疗后破裂的心肌内血肿的缓解情况。我们认为多排螺旋计算机断层扫描有助于追踪心肌内血肿的自然病程。
