Background:

Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process, with very scarce reports in medical literature. Usually caused by a haemorrhagic dissection among the spiral myocardial fibres.

Case report:

Here we report the case of a 60-year-old man with a previous infarction in the inferior wall extended to the right ventricle, in whom a dissecting intramyocardial haematoma in the free wall of the right ventricle was identified using transthoracic and contrast echocardiography, corroborated with cardiac magnetic resonance.

Results:

By this imaging modalities, it was possible to see the various acoustic densities of the progressive clotting of the hematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers.

Conclusion:

The patient presented a gradual improvement and hemodynamic stability, and basing on the existent medical literature, it was decided the medical treatment as the therapeutic option, maintaining asymptomatic after three months of follow-up.