A case report of intramyocardial dissecting hematoma: a challenging diagnosis

Intramyocardial dissecting hematoma (IDH) is an uncommon complication of myocardial infarction that can potentially lead to cardiac rupture.[1] Two distinguishable types of cardiac rupture have been identified: a simple tear, which is the most common case and is characterized by a lineal or tortuous tear along the myocardial wall, and complex hemorrhagic dissection. IDH is generally classified as complex hemorrhagic dissection, in which blood infiltrates into the myocardial wall.[2] IDH is characterized by a serpiginous tract within the myocardium, which is also known as subepicardial aneurysm. The mechanisms of IDH are multifactorial and contribute to the rupture of intramyocardial vessels, diminished tensile strength of the infarcted myocardium, abrupt increases in perfusion pressure during the perfusion phase, or in rare cases, iatrogenesis.[3] Furthermore, the anatomical substrate of IDH is the spiral helical structure of the heart that favors hemorrhage spreading along the spiral myocardial fibers.[4] IDH is often a challenging diagnosis and prone to misdiagnosis because of its rarity and various clinical presentations. Here, we report a patient with IDH.