Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey.
Int J Cardiovasc Imaging. 2024 Sep;40(9):2019-2020. doi: 10.1007/s10554-024-03236-2. Epub 2024 Sep 21.
Intramyocardial dissecting hematoma (IDH) usually develops from hypoxia-induced capillary destruction within the myocardium following ischemia. The hematoma then infiltrates the interstices between myocardial spiral fibers, establishing a neocavity. As intra-neocavitary pressure increases, the hematoma expands and occasionally becomes associated with the epicardium or ventricular cavity (Roslan A et al. (2017) Intramyocardial dissecting hematoma in patients with ischemic cardiomyopathy: role of multimodality imaging in three patients treated conservatively. CASE: Cardiovasc Imaging Case Rep 1(4):159). Differential diagnoses include prominent ventricular trabeculations, intracavitary thrombosis, and pseudoaneurysm. By confirming the integrity of the epicardium, IDH can be distinguished from pseudoaneurysm, characterized by a complete rupture of the myocardial wall enclosed by the pericardium. Clear identification of the endocardium surrounding the hematoma and its systolic expansion may help to differentiate IDH from intracavitary hematoma. Prominent trabeculations can be recognized by a ventricular wall with an utterly asymmetric flow pattern (Vasco Dias (June 2009) et al., Intramyocardial dissecting haematoma: a rare complication of acute myocardial infarction. Eur J Echocardiography 10(4):585-587).
心肌内血肿（IDH）通常是由于缺血后心肌内缺氧引起的毛细血管破坏所致。血肿随后渗透到心肌螺旋纤维之间的间隙中，形成一个新腔。随着新腔内压力的增加，血肿会扩张，偶尔会与心外膜或心室腔相关联（Roslan A 等人（2017 年）缺血性心肌病患者的心肌内血肿：三种保守治疗患者的多模态成像作用。案例：心血管成像病例报告 1（4）：159）。鉴别诊断包括明显的心室小梁、心腔内血栓形成和假性动脉瘤。通过确认心外膜的完整性，可以将 IDH 与假性动脉瘤区分开来，假性动脉瘤的特征是心包所包围的心肌壁完全破裂。清楚地识别血肿周围的心内膜及其收缩期扩张有助于将 IDH 与心腔内血肿区分开来。通过心室壁上完全不对称的血流模式可以识别明显的小梁（Vasco Dias（2009 年 6 月）等人，心肌内血肿：急性心肌梗死的罕见并发症。欧洲超声心动图杂志 10（4）：585-587）。
