Complete recovery of the right ventricle from a large intramyocardial hematoma complicating percutaneous coronary intervention

Right ventricular (RV) intramyocardial hematoma is a potentially life-threatening condition that can complicate percutaneous coronary intervention (PCI). Natural course of RV hematoma and long-term recovery of the affected myocardium have not been described. We present a case of a 70-year-old male with large RV hematoma caused by distal guidewire perforation during PCI of the right coronary artery. Baseline multimodality imaging, serial echocardiography, and long-term follow-up using cardiac magnetic resonance (CMR) imaging were used to investigate the natural course of this rare condition. Despite its massive initial appearance, the hematoma was successfully managed conservatively. Serial echocardiographic examination showed slow gradual resorption of the hematoma. Follow-up CMR performed at 12 months was strikingly normal, showing no late gadolinium enhancement of the RV myocardium indicating lack of significant fibrotic scarring at the site of hematoma resorption. <Learning objective: Right ventricular (RV) free wall hematoma is a potentially life-threatening complication of percutaneous coronary intervention. Multimodality imaging combined with serial echocardiography is useful to study the extent of myocardial involvement and the slow resorption process of the hematoma. This case illustrates that even a sizeable RV intramyocardial hematoma can be managed conservatively if no acute hemodynamic compromise occurs and complete recovery of the myocardium can be expected.>.