This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hosaka, Y. Articles by Aizawa, Y. Search for Related Content PubMed PubMed Citation Articles by Hosaka, Y. Articles by Aizawa, Y. Pubmed/NCBI databases Medline Plus Health Information Bruises Cardiomyopathy

(Circulation. 2004;109:277.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Intramyocardial Hemorrhage Caused by Myocardial Contusion

Yukio Hosaka, MD, PhD; Makoto Kodama, MD, PhD; Masaomi Chinushi, MD, PhD; Takashi Washizuka, MD, PhD; Hirotaka Sugiura, MD; Kouji Satou, MD, PhD; Yoshifusa Aizawa, MD, PhD

From the Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences (Y.H., M.K., M.C., T.W., H.S., Y.A.), and the Department of Internal Medicine, Niigata Prefectural Koide Hospital (K.S.), Japan.

Correspondence to Yukio Hosaka, MD, PhD, Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-754, Niigata, 951-8510 Japan. E-mail hosaka{at}med.niigata-u.ac.jp

A49-year-old man was referred to our hospital after a syncopal attack and blunt chest trauma suffered in a collision with another skier on a ski slope. On admission, he complained of chest and left thigh pain, although his consciousness was clear. His ECG showed atrial fibrillation with a complete right bundle-branch block pattern and ST-segment elevation in leads I, aVL, and V₂ through V₅ (Figure 1). Echocardiography showed diffuse hypokinetic wall motion of the left ventricle but no pericardial effusion. The results of brain and chest computerized tomographic images were normal.

View larger version (88K): [in this window] [in a new window]   Figure 1. Twelve-lead ECG on admission shows a wide-complex tachycardia with atrial fibrillation, complete right bundle-branch block, left anterior hemiblock, Q waves (V1 through V4), ST-segment elevation (I, aVR, aVL, and V2 through V5), and ST-segment depression (II, III, aVF, V1, and V6).

After his admission to the intensive care unit, ventricular fibrillation suddenly developed, and he died a few hours later. Postmortem examination showed myocardial contusion without coronary artery injury. Histological analysis revealed severe intramyocardial hemorrhage and disruption of myocardial tissue (Figure 2).

View larger version (63K): [in this window] [in a new window]   Figure 2. Transverse section of the heart at the level of papillary muscles (A) and light photomicrograph (hematoxylin-and-eosin stain, magnification x100) of a section of the anterior myocardial wall (B). Intramyocardial hemorrhage is recognized at the anteroseptal, anterior, anterolateral, lateral, and posterolateral regions. At the anterior segment, the disruption of myocardial tissue and the infiltration of erythrocytes are observed without leukocytes.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				C. Jahnke, R. Hetzer, T. Komoda, E. Fleck, and I. Paetsch Intramural Dissecting Hemorrhage of the Myocardium Circulation, May 15, 2007; 115(19): e457 - e459. [Full Text] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hosaka, Y. Articles by Aizawa, Y. Search for Related Content PubMed PubMed Citation Articles by Hosaka, Y. Articles by Aizawa, Y. Pubmed/NCBI databases Medline Plus Health Information Bruises Cardiomyopathy