Department of Ultrasound, The First College of Clinical Medical Science, China Three Gorges University, 183 Yiling Road, Yichang, 443003, Hubei, China.
J Cardiothorac Surg. 2024 Oct 10;19(1):601. doi: 10.1186/s13019-024-03084-0.
Intramyocardial dissecting hematoma (IDH) is a rare mechanical complication following myocardial infarction (MI), and only a few isolated cases have been reported to date. IDH presents with diverse clinical manifestations, often resulting in missed or misdiagnosed cases due to limited physician understanding. The diagnosis and treatment of IDH is a major challenge.
We report a case of acute extensive anterior MI in a 73-year-old woman, who underwent percutaneous coronary intervention (PCI); the left ventricular intramyocardial dissecting hematoma (LVIDH) penetrated the right ventricular outflow tract (RVOT), resulting in thrombus formation and subsequent RVOT obstruction. Clinically insignificant IDH was detected by transthoracic echocardiography (TTE) at 3 days, 43 days, and 75 days post-PCI, with characteristic changes in the left ventricular wall ultrasound images. This unusual case highlights the important role of continuous transthoracic echocardiography in identifying this rare complication of LVIDH. After a detailed discussion with the patient, the choice between conservative or surgical management of IDH depends on factors such as the size of the hematomae, left ventricular systolic function, and the patient's clinical and haemodynamic status. In this particular case, conservative management was chosen by the patient who declined surgery but unfortunately succumbed to cardiogenic shock.
This case describes a rare complication of acute myocardial infarction (AMI) and also focuses on the utility of TTE in the diagnosis of this rare complication. Whether LVIDH is treated conservatively or surgically requires careful evaluation to achieve the best prognosis for the patient.
心肌内血肿（IDH）是心肌梗死后一种罕见的机械性并发症，迄今为止仅报道了少数几例孤立病例。IDH 的临床表现多种多样，由于医生对此了解有限，常导致漏诊或误诊。IDH 的诊断和治疗是一个重大挑战。
我们报告了一例 73 岁女性急性广泛前壁心肌梗死病例，该患者接受了经皮冠状动脉介入治疗（PCI）；左心室心肌内血肿（LVIDH）穿透右心室流出道（RVOT），导致血栓形成和随后的 RVOT 阻塞。经胸超声心动图（TTE）在 PCI 后 3 天、43 天和 75 天检测到临床意义不显著的 IDH，左心室壁超声图像有特征性改变。这个不寻常的病例强调了连续 TTE 在识别这种罕见的 LVIDH 并发症中的重要作用。在与患者进行详细讨论后，IDH 的保守或手术治疗选择取决于血肿大小、左心室收缩功能以及患者的临床和血液动力学状况等因素。在本例中，患者选择了保守治疗，但拒绝手术，不幸的是，患者最终死于心源性休克。
本病例描述了急性心肌梗死（AMI）的一种罕见并发症，并重点介绍了 TTE 在诊断这种罕见并发症中的应用。LVIDH 是否保守或手术治疗需要仔细评估，以实现患者的最佳预后。
