Conservatively treated intramyocardial dissecting haematoma of the interventricular septum as a rare complication of acute myocardial infarction: a case report

Background Intramyocardial dissecting haematoma (IDH) is a rare and potentially life-threatening complication of acute coronary syndrome. So far only isolated case reports and case series have been published. Case summary We report the case of a late presenting myocardial infarction (MI) complicated by IDH of the ventricular septum, following a successful percutaneous coronary intervention (PCI). The clinically inapparent septal mass was discovered during the routine transthoracic echocardiography and the final diagnosis of haematoma was made by magnetic resonance imaging. The patient remained clinically stable, and septal mass on repeated echocardiography showed gradual regression. Discussion This report suggests that IDH can spontaneously resolve without surgical intervention. An urgent echocardiogram should be used to assess the vitality of the myocardial tissue, especially with late presenting MI with deep Q-waves on the electrocardiogram strip. Conservative treatment in haemodynamically stable patients with IDH following MI and PCI is a feasible solution.