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(Circulation. 1998;97:2470-2472.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Intramyocardial Dissecting Hematoma

Vinayak Nilkanth Bapat, MS; Ajay Madhukar Naik, MD; Yash Lokhandwala, MD, DM; ; Anil Gangadhar Tendolkar, MS

From the Departments of Cardiovascular and Thoracic Surgery (V.N.B., A.G.T.) and Cardiology (A.M.N., Y.L.), Seth G.S. Medical College and King Edward VII Memorial Hospital, Bombay, India.

Correspondence to Dr Vinayak N. Bapat, A 60/574, MIG Colony, Bandra (E), Bombay 400 051, India.

A26-year-old man was admitted to a private nursing home in December 1995 with the sudden onset of palpitations. He was diagnosed as having ventricular tachycardia (monomorphic, left-axis -60°; rate, 210 bpm) with pronounced hemodynamic instability. He was electrically cardioverted to sinus rhythm. Clinical examination revealed a normal heart with no obvious structural heart disease and no metabolic precipitants. Because he had repeated episodes of ventricular tachycardia, he was started on 1000 mg/d amiodarone, which was tapered to 400 mg/d by the end of 1 week. Echocardiographic results were normal. The patient remained asymptomatic until February 1996, when he had a similar episode of palpitations. At this stage, he was referred to us for further management.

Physical examination was normal except for cardiomegaly, which was confirmed on chest roentgenography. Echocardiography revealed a uniformly echogenic mass of 8.5x8 cm in relation to the right ventricle (Fig 1A), which was visualized as a crescentic cavity. The proximal right coronary artery was dilated; the remainder of the chambers were normal. A repeat echocardiogram after 7 days showed mixed echogenicity in the mass (Fig 1B). A diagnosis of pericardial hematoma was considered. Magnetic resonance imaging of the heart was performed to confirm the diagnosis, but the scan indicated the presence of an intracardiac mass (Fig 1C). Cardiac catheterization was performed to determine the relation of the coronary vessels to the mass and to assess the right coronary artery; it revealed a dilated proximal right coronary artery with an abrupt termination, with the . . . [Full Text of this Article]

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