[Intracavitary thrombus as a differential diagnosis of intramyocardial dissection]

We present the case of a 47-year-old man with ischemic cardiomyopathy and a previous extensive acute myocardial infarction (AMI), who had undergone multiple percutaneous coronary interventions and progressed to advanced heart failure. During evaluation as a candidate for cardiac transplantation, transthoracic echocardiography revealed an image compatible with either an intracavitary thrombus (ICT) or an intramyocardial dissection (IMD), a finding also identified on cardiac computed tomography. Due to progressive hemodynamic deterioration, cardiac magnetic resonance imaging could not be performed. Anticoagulation with unfractionated heparin was initiated, and follow-up imaging demonstrated complete resolution of the lesion, supporting the diagnosis of ICT. The patient subsequently underwent successful cardiac transplantation, and histopathological analysis of the explanted heart confirmed a partially organized ICT, ruling out IMD. This case underscores the importance of differentiating between these two entities, where multimodality imaging and temporal evolution play a fundamental role in guiding therapeutic decisions.