Intramyocardial Hemorrhage Caused by Myocardial Contusion
A 49-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.
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).
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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