Abstract
Intramyocardial dissecting hematoma (IDH) is a rare, life-threatening complication of myocardial infarction without established treatment guidelines. We described the case of a 55-year-old man who presented with acute heart failure. Transthoracic echocardiography initially showed a left ventricular thrombus, leading to anticoagulation therapy. However, follow-up imaging revealed progressive enlargement and heterogeneous echogenicity of the mass. Cardiac magnetic resonance imaging confirmed the diagnosis of IDH secondary to chronic myocardial infarction. Given the patient's hemodynamic stability, anticoagulation was discontinued, and he underwent conservative management. After six months, the hematoma gradually regressed, and patient remained hemodynamically stable without undergoing surgery. To the best of our knowledge, this is the first reported case of a progressively enlarging IDH that was successfully managed conservatively, highlighting the critical role of multimodality imaging in guiding nonsurgical treatment decisions.