Spontaneous Resolution of Post‐Myocardial Infarction Intramyocardial Dissecting Hematoma: A Case Report

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Abstract
Intramyocardial dissecting hematoma (IDH) is a rare mechanical complication following acute myocardial infarction, characterized by blood accumulation within myocardial layers without complete rupture. Clinical outcomes are highly variable, ranging from spontaneous resolution to death. The optimal management strategy remains unclear, particularly regarding the role of conservative versus surgical approaches in hemodynamically stable patients. A 79‐year‐old male presented 1 month after anterior myocardial infarction treated with percutaneous coronary intervention. Echocardiography revealed a large (70 × 80 mm) heterogeneous mass with scattered echolucent spaces occupying more than half of the left ventricular cavity, originating from the akinetic apex and extending along the interventricular septum. Unlike typical thrombus, no communication with ventricular cavities or color Doppler flow was detected. Cardiac computed tomography revealed a hypodense, non‐enhancing lesion (91 × 70 mm), raising the possibility of an intramyocardial hematoma. Despite the massive intracardiac mass, the patient remained hemodynamically stable. Serial echocardiographic monitoring over 2 weeks documented progressive hematoma reduction without additional medical intervention, anticoagulation, or surgical management. Complete resolution of the hematoma occurred without progression to ventricular septal rupture or free wall rupture. Spontaneous resolution of post‐myocardial infarction IDH can occur in hemodynamically stable patients without surgical intervention. Serial echocardiographic monitoring is essential for detecting spontaneous regression and guiding management decisions. This case highlights the potential role of conservative management with close imaging surveillance and suggests that conservative management may represent an alternative to surgery in selected patients, particularly those who are hemodynamically stable.

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