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

Authors

Xinhua Qin, Zeyu Chen, Hongjun Xiang

Published in

Frontiers in cardiovascular medicine. Volume 13. Pages 1910250. Epub Sep 22, 2026.

Abstract

Intramyocardial dissecting hematoma (IDH) is a rare and potentially fatal form of myocardial rupture that usually occurs following acute myocardial infarction (AMI). Due to its low incidence and nonspecific clinical manifestations, IDH is frequently misdiagnosed as left ventricular thrombus or pseudoaneurysm. Multimodality imaging, particularly cardiac magnetic resonance (CMR), plays a pivotal role in establishing the diagnosis and guiding treatment strategies.
A 36-year-old man with a long-term smoking history presented with progressive chest tightness and dyspnea for two weeks. Electrocardiography demonstrated pathological Q waves with persistent ST-segment elevation in leads V2-V6, suggestive of subacute anterior myocardial infarction. Laboratory investigations revealed elevated cardiac troponin T and markedly increased N-terminal pro-brain natriuretic peptide levels. Transthoracic echocardiography showed severe left ventricular systolic dysfunction with a left ventricular ejection fraction (LVEF) of 29% and a heterogeneous apical mass measuring 63 × 57 × 25 mm. Contrast-enhanced computed tomography and cardiac magnetic resonance imaging identified a large lesion extending from the interventricular septum to the apex, highly suggestive of intramyocardial dissecting hematoma. Coronary angiography revealed severe proximal stenosis and complete mid-segment occlusion of the left anterior descending artery (LAD). The patient underwent successful percutaneous coronary intervention with implantation of three drug-eluting stents, achieving TIMI grade 3 flow. Following guideline-directed medical therapy, the patient's symptoms improved significantly without hemodynamic deterioration or hematoma progression.
This case highlights the importance of considering IDH in patients with subacute myocardial infarction presenting with left ventricular masses. Multimodality imaging, particularly CMR, is essential for differential diagnosis and therapeutic decision-making. Conservative management after successful revascularization may be feasible in hemodynamically stable patients with IDH.

PMID:
42840997
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.