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Journal of Medical Ultrasonics

にて英文誌のFull textを閲覧することができます.


2015 - Vol.42

Vol.42 No.05

Case Report(症例報告)

(0631 - 0636)


Intramyocardial dissecting hematoma incidentally diagnosed with heart failure: a case report

田端 智香1, 岡田 昌子2, 森 智美3, 寺本 美穂3, 小笠原 延行1, 三好 美和1, 佐伯 一1, 中川 雅美1, 酒井 晋介4, 長谷川 新治1

Tomoka TABATA1, Masako OKADA2, Tomomi MORI3, Miho TERAMOTO3, Nobuyuki OGASAWARA1, Miwa MIYOSHI1, Hajime SAEKI1, Masami NAKAGAWA1, Shinsuke SAKAI4, Shinji HASEGAWA1

1地域医療機能推進機構大阪病院循環器内科, 2地域医療機能推進機構大阪病院臨床検査科, 3地域医療機能推進機構大阪病院臨床検査部, 4地域医療機能推進機構大阪病院内科

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

キーワード : intramyocardial dissecting hematoma, echocardiography, CT, RI, coronary angiography


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.