Surgical treatment of intramyocardial dissecting hematoma-a case report and literature review.

Background: Intramyocardial dissecting hematoma (IDH) is a rare but potentially life-threatening complication, most commonly linked to myocardial infarction (MI) but also described in other settings such as cardiac interventions or severe chest trauma. Owing to the limited data on its diagnosis, management, and outcomes, treatment strategies for IDH remain controversial. Case presentation: We present a case of a 53-year-old female who was initially misdiagnosed with Takotsubo cardiomyopathy and later found to have an IDH complicated by anticoagulation dilemmas and infection. Despite initial conservative management, progressive dissection and elevation of inflammatory markers prompted surgical intervention. The patient underwent endoventricular patch repair (Dor procedure), with successful resolution and functional recovery through rehabilitation. Conclusions: This case highlights the importance of keeping IDH in the differential diagnosis, especially in patients with non obstructive coronary findings or unexplained myocardial wall abnormalities. Multimodal imaging, especially cardiac MRI, plays a key role in confirming the diagnosis and determining the extent of dissection. Treatment should be highly individualized, balancing the risks of hematoma expansion against the need for anticoagulation when intracavitary thrombi are present. Infection risk can further complicate the clinical course, necessitating early recognition and intervention. When conservative management is no longer viable, surgical repair-such as the Dor procedure-can stabilize the myocardium and lead to meaningful recovery.