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

backgroundIntramyocardial dissecting hematoma is a rare complication of percutaneous coronary intervention. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGE: Multimodality imaging facilitates diagnosing intramural hematoma, a rare but potentially life-threatening complication.