# Multimodality Imaging of Intramyocardial Dissecting Hematoma: A Rare, Potentially Fatal Complication of Percutaneous Coronary Intervention

## TL;DR

A rare and dangerous heart condition called intramyocardial dissecting hematoma occurred after a heart procedure, and was diagnosed and managed using multiple imaging techniques.

## Contribution

The paper presents a unique case of intramyocardial hematoma following percutaneous coronary intervention, highlighting the role of multimodality imaging in diagnosis and management.

## Key findings

- Multimodality imaging confirmed intramyocardial hematoma and transmural myocardial infarction.
- Covered stent placement stabilized the condition and likely prevented septal wall rupture.
- Subclinical myocardial infarction with spontaneous reperfusion may predispose to hematoma expansion.

## Abstract

Intramyocardial dissecting hematoma is a rare complication of percutaneous coronary intervention.

A 56-year-old patient underwent percutaneous coronary intervention with successful right coronary artery stenting, complicated by distal wire perforation and contrast extravasation. Although initially managed conservatively, follow-up echocardiography showed a rapidly expanding septal intramyocardial hematoma. Urgent coronary angiography demonstrated multiple sites of contrast accumulation, which progressed despite balloon inflation, but ultimately stabilized after covered stent placement. Cardiovascular magnetic resonance and computed tomography angiography confirmed the diagnosis of intramyocardial hematoma and revealed transmural myocardial infarction with microvascular obstruction.

Most reports describe intramyocardial hematomas in chronic total occlusion or prior bypass surgery. In this case, multimodality imaging suggests subclinical myocardial infarction with spontaneous reperfusion, creating a vulnerable environment for rapid hematoma expansion. Covered stent placement likely prevented septal wall rupture.

Multimodality imaging facilitates diagnosing intramural hematoma, a rare but potentially life-threatening complication.