Two- and three-dimensional transesophageal echocardiographic diagnosis of intramyocardial dissecting hematoma after myocardial infarction

The echocardiographic findings of an intramyocardial dissecting hematoma th at formed after an extensive acute myocardial infarction of the anterior wa ll of a 42-year-old man are described. Serial transesophageal studies were used to construct 3-dimensional images that clarified the participation of various myocardial layers that surrounded the dissecting hematoma. The pati ent was successfully treated with intra-aortic balloon counterpulsation and subsequently coronary artery bypass grafting. Intramyocardial dissecting h ematoma is a rare complication of acute infarction; differential diagnosis must be made with pseudoaneurysm by establishing integrity of epicardium an d with intracavitary thrombosis by identifying the endomyocardial layer sur rounding the neoformation and associated wall movement.