Intramural atrial hematoma: a rare complication of a common procedure

Intramural hematoma is a rare complication of percutaneous coronary intervention (PCI) and it is mostly related to a poor prognosis. Moreover, although the best clinical treatment is unclear, the choice of appropriate imaging techniques can be helpful to manage these patients. We describe a case of a 79-year-old woman with an intramural atrial hematoma, likely caused by dissection of a distal coronary artery side branch during PCI. Imaging features at standard echocardiography did not provide enough information about consistency, blood supply, and relationship of the mass with the nearest structures. Only by performing myocardial contrast echocardiography (MCE), we obtained a clear characterization of extent and blood supply status of the hematoma over time. Indeed, MCE is a simple, rapid, cheap, bedside, and safe imaging tool able to not invasively perform a better visualization of endocardial borders and evaluate the distribution of the intravascular ultrasound contrast agent within myocardial wall. Moreover, thanks to the absence of radiation risk and the extremely good patient tolerance, MCE represents a repeatable imaging tool useful to assess evolution of hematoma over time