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Tex Heart Inst J. 2012; 39(5): 768–769.
PMCID: PMC3461656

Intramyocardial Hematoma from Blunt Trauma Mimicking Apical Hypertrophic Cardiomyopathy

Meta Linda Mobula, MD, Sammy Zakaria, MD, MPH, and Glenn A. Hirsch, MD, MHS
Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin St., Suite 2480, Houston, TX 77030

A 17-year-old boy was assaulted by 3 men wielding baseball bats. Among multiple injuries, he sustained an injury to his left thorax (Fig. 1) with an associated pulmonary contusion but without pneumothorax or rib fractures. The patient's initial troponin I level of 1.35 ng/mL peaked 2 days later at 3.43 ng/mL. In addition, the initial electrocardiogram was markedly abnormal, with precordial R-wave and T-wave changes similar to those seen in apical hypertrophic cardiomyopathy (Fig. 2). A transthoracic echocardiogram revealed a left ventricular intramyocardial mass that extended from the mid lateral and apical lateral segments to the apex (Fig. 3). However, a diagnosis of left ventricular free-wall rupture with pseudoaneurysm formation could not be excluded. Cardiac magnetic resonance showed the intramyocardial location of the mass (Fig. 4). This finding, along with the history, was consistent with an intramyocardial hematoma from blunt chest trauma. While hospitalized, the patient remained hemodynamically stable without arrhythmias, and serial electrocardiograms showed decreasing T-wave inversions that did not completely resolve before the patient's discharge from the hospital. Ten months later, cardiac magnetic resonance showed that the intramyocardial mass had decreased in size (Fig. 5).

figure 45FF1
Fig. 1 Photograph of left lateral chest wall shows the location of the baseball bat strike that was most likely responsible for the intramyocardial hematoma.
figure 45FF2
Fig. 2 Initial electrocardiogram shows deep T-wave inversions and large R waves in the precordial leads, similar to findings in apical hypertrophic cardiomyopathy.
figure 45FF3
Fig. 3 Transthoracic echocardiogram (4-chamber apical view) reveals a left ventricular intramyocardial mass extending from the mid lateral and apical lateral segments to the apex. The apical lateral mass is indicated by arrows.
figure 45FF4
Fig. 4 Cardiac magnetic resonance (4-chamber view) shows the intramyocardial location of the mass (arrow), which does not involve the bright signal of normal pericardial fluid (arrowhead).
figure 45FF5
Fig. 5 Cardiac magnetic resonance image (4-chamber view) upon 10-month follow-up shows a decrease in the size of the apical lateral intramyocardial mass.


Intramyocardial hematomas are rarely clinically apparent after chest trauma. In one autopsy series,1 14% of patients with chest trauma had myocardial hemorrhage. Arrhythmias or repolarization abnormalities on electrocardiography suggest ischemia from a coronary artery injury (such as dissection) or direct myocardial injury (such as contusion); additional testing such as cardiac imaging could be necessary to further define the injury.

Supplementary Material

Video for Fig. 3:
Video for Fig. 4:


Address for reprints: Glenn A. Hirsch, MD, MHS, 550 S. Jackson St., ACB-A3L42, Louisville, KY 40292

E-mail: ude.ellivsiuol@hcsrih.nnelg


1. Wisner DH, Reed WH, Riddick RS. Suspected myocardial contusion. Triage and indications for monitoring. Ann Surg 1990;212(1):82–6. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute