Lovasz David, Camboni Daniele, Zeller Judith, Schmid Christof
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Eur Heart J Case Rep. 2021 Feb 18;5(2):ytaa579. doi: 10.1093/ehjcr/ytaa579. eCollection 2021 Feb.
Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far.
We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echocardiography and confirmed by both computed tomography (CT) and magnetic resonance imaging (MRI). With non-surgical treatment, the patient remained clinically stable. Repeated echocardiography showed gradual regression of the haematoma. Follow-up echocardiography 3 months after the initial diagnosis demonstrated no evidence of septal haematoma.
This report suggests that even large intramyocardial haematoma may recede without operative intervention. Echocardiography, CT, and MRI are all helpful in quantifying the size of the haematoma. The appropriate management should be patient-oriented, depending on clinical stability and progression of the haematoma. Conservative treatment in clinically stable patients suffering from septal haematoma following MI and coronary intervention can be a feasible option.
心肌内夹层血肿是心肌梗死（MI）一种罕见且可能危及生命的并发症。目前仅报道了少数孤立病例。
我们报告了一例因右冠状动脉（RCA）斑块破裂导致心肌梗死后出现巨大、阻塞性室间隔心肌内血肿的患者病例，该患者在冠状动脉介入治疗成功后出现此情况。临床上不易察觉的血肿在常规超声心动图检查时被发现，并经计算机断层扫描（CT）和磁共振成像（MRI）证实。通过非手术治疗，患者临床情况保持稳定。重复超声心动图检查显示血肿逐渐消退。初次诊断3个月后的随访超声心动图检查未发现室间隔血肿迹象。
本报告提示，即使是巨大的心肌内血肿也可能在无手术干预的情况下消退。超声心动图、CT和MRI均有助于量化血肿大小。合适的治疗方案应以患者为导向，取决于临床稳定性和血肿进展情况。对于心肌梗死后和冠状动脉介入治疗后患有室间隔血肿且临床稳定的患者，保守治疗可能是一种可行的选择。
