1Department of Cardiovascular Medicine, Japan Community Healthcare Organization Osaka Hospital, 2Department of Laboratory, Japan Community Healthcare Organization Osaka Hospital, 3Clinical Laboratory, Japan Community Healthcare Organization Osaka Hospital, 4Department of Internal Medicine, Japan Community Healthcare Organization Osaka Hospital
A 74-year-old male with a chronic kidney disorder was admitted to our hospital because of general malaise and dyspnea during hemodialysis. On his initial visit, he was hypoxic. A chest X-ray showed bilateral congestion shadow and dilatation of heart shadow. He had a diagnosis of acute heart failure. Transthoracic echocardiography (TTE) revealed reduced cardiac ejection fraction and an intramyocardial dissecting hematoma (IDH) at the apical lesion. Based on coronary angiography and myocardial scintigraphy, the hematoma was assumed to have been induced by pre-existing asymptomatic myocardial infarction. This was not a case of acute myocardial infarction, and repeated TTE did not show enlargement of the hematoma or increase in pericardial effusion. Therefore, we treated him conservatively. The fluid volume was controlled with hemodialysis and his symptom improved. He was discharged within about one month. After discharge, the hematoma was invariant for 12 months on TTE, and the patient made steady progress. Although IDH is a potentially lethal disease, we concluded that surgery was not always essential for all patients with IDH based on frequent observations.