Intramural hemotoma presenting as acute coronary syndrome: the importance of intravascular ultrasound.
Intramural hematoma in major coronary epicardial vessels is a rare cause of chest pain. Afflicted  individuals may present with acute coronary syndrome (ACS) or even sudden cardiac  death. Spontaneous, isolated intramural hematoma may occur in the absence of associated  intimal dissection. In this situation, lesions may be angiographically indistinguishable from  ruptured atherosclerotic plaque. Intravascular ultrasound is important in the accurate diagnosis  of isolated intramural hematoma. Although coronary stenting may be required in the presence of  ongoing ischemia, intramural hematoma may be successfully managed medically. We describe  the case of a middle-aged woman who presented with ACS due to an intramural hematoma and  discuss the diagnosis and management of this rare illness.
Department of Interventional Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
Yogesh
Y
Raja
Jasper
J
Trevelyan
Sagar N
SN
Doshi
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D011237:Predictive Value of Tests; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional