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Spontaneous intramyocardial hematoma presenting as a rapidly expanding mass followed by echocardiography
Hisato Takagi1, Yoshio Mori, Hisashi Iwata
1First Department of Surgery, Gifu University School of Medicine, 40 Tsukasa, Gifu 500-8705, Japan. h-takagi@cc.gifu-u.ac.jp
Insights
A patient with a history of heart aneurysm underwent resection of a rapidly expanding intramyocardial hematoma. Surgical removal and xenopericardium patch successfully treated the cardiac mass.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- A 50-year-old male presented with a history of coronary arterial and left ventricular (LV) aneurysm resection.
- He had a newly diagnosed, rapidly expanding intramyocardial mass.
Observation:
- Two-dimensional echocardiography revealed a heterogeneous mass in the LV posterior wall.
- Intraoperative findings confirmed an intramyocardial hematoma not connected to the LV cavity.
Findings:
- Complete resection of the outer layer of the intramyocardial hematoma was performed.
- The defect was reconstructed using a xenopericardium graft.
Implications:
- This case highlights successful surgical management of an intramyocardial hematoma.
- Xenopericardium patching provides a viable option for reconstructing myocardial defects post-hematoma resection.
Abstract:
A50-year-old man with an intramyocardial mass was referred to us. He had undergone resection of both a coronary arterial aneurysm of unknown origin and a postinfarction left ventricular (LV) aneurysm 5 years before. Peak creatine kinase was slightly over the upper normal range, and an electrocardiogram revealed neither a new Q-wave nor an additional ST-segment change. Repeated two-dimensional echocardiography indicated rapid expansion of a heterogeneous mass in the posterior wall of the LV. The mass was intraoperatively diagnosed as intramyocardial hematoma without connection to the LV cavity. Via posterolateral thoracotomy with partial cardiopulmonary bypass, the outer layer of the hematoma was completely resected, and xenopericardium was applied with a continuous suture to cover the space which the hematoma had occupied. The patient made an uneventful recovery.