Large Coronary Intramural Hematoma Presenting as Acute Coronay Syndrome

Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial– adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is infrequent and serious coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both diagnostics and treatment strategy. We report a case of intramural coronary hematoma in a patient presenting with non ST- -segment elevation myocardial infarction.