PMC7849839_01
(a): Transthoracic 2D echocardiogram; (b, c): CT scan without (b) and with (c) injection: a. Hyper-echoic image facing the tip of the left ventricle (LV) (yellow arrow). b, c: A spontaneous hyperdense formation Non-enhanced after contrast injection associated with a bilateral pericardial and pleural effusion blade.
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The pericardial effusion of low abundance opposite the anterior and lateral wall of the right ventricle and a hyper-echoic image measuring 59 x 32 mm facing the tip of the LV were detected (Fig. 1a). The spontaneous density was 41 HU, not raised after injection of contrast agent evoking an intramural hematoma (Fig. 1-b-c).
(a, d, e, f) Late Gadolinium Enhancement (LGE); (b) T1-Weighted Spin Echo Sequence; (c) First-Pass Gadolinium Infusion Sequence; (a,c,d) minor axis of the LV; (b,e,f) axial 4 cavities: Dissecting hematoma of the anterior myocardial wall in signal vacuum on EG and hypersignal T1 sequences (blue arrows). Two thrombi in the LV, one of which is a wall thrombus lining the bottom of the hematoma (red arrows). Late subendocardial and transmural elevation in places (yellow arrows) in antero-septal, infero-septal, middle and apical LV walls due to ischemia in the territory of the left anterior descending artery (LAD). The outer edge of the hematoma is bounded by the infarcted myocardial tissue.
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The outer edge of the hematoma was bounded by the infarcted myocardial tissue (Fig. 2).
Control MRI after 20 days: SSFP (steady-state free-precession) Cine Sequence: Axial 4 cavities (a), (b) long axis of the LV: Partial regression of dissecting intra myocardial hematoma (yellow arrows).
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The CMR control after 20 days showed a partial regression of dissecting intra myocardial hematoma (Fig. 3).
Subsequent 2D trans-thoracic echocardiography 3 months later showing Increased echogenicity over the apex (yellow arrows), consistent with thrombus formation.
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The subsequent echocardiography repeated during the follow-up 3 months later showed a slight improvement of the LV ejection fraction with an increased echogenicity over the apex, consistent with a focal thrombosis (Fig. 4).