Coronary Hematoma Visualized by Intravascular Ultrasound and Magnetic Resonance Imaging
Transluminal interventions such as balloon dilation, directional atherectomy, and stenting for coronary artery disease sometimes induce vessel wall dissection associated with the formation of an intramural hematoma. In a patient who underwent stent deployment in the mid-right coronary artery (Figure 1A), intravascular ultrasound demonstrated a semilunar-shaped area just proximal to the edge of the stent (Figure 1B). The echo intensity and characteristic shape of the image indicated an intramural hematoma. The coronary site proximal to this portion had circumferential disease with acoustic shadowing that suggested the presence of a calcified lesion (Figure 1C). MRI with fat suppression and dark-blood preparation also showed a semilunar-shaped area that occupied approximately half of the vessel lumen (Figure 2A). The coronary site proximal to this image had a well-preserved lumen with a circumferential high-intensity wall image compatible with the ultrasound findings (Figure 2B). Thus, the hematoma was noninvasively detected by MRI. Coronary angiography performed 1 month after these procedures demonstrated total occlusion of the right coronary at the site where the hematoma had been identified. We suggest that MRI, as well as intravascular ultrasound imaging, can detect a coronary hematoma, which may be one of the causes of subacute vessel occlusion after interventional procedures.
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.
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