A 37-year-old man with an evolving anterior myocardial infarction received intracoronary thrombolytic therapy six hours after its onset. The restored coronary artery patency was recorded angiographically in the left anterior descending coronary artery (LAD). He died 28 hours after administration of the therapy. Uniform and severe interstitial hemorrhage was present in the area of myocardial necrosis. The distribution of hemorrhage and myocardial necrosis corresponded with the vascular bed of the LAD and was thus consistent with experimental studies that concluded that the hemorrhagic areas were probably confined to muscle that was already necrotic.