• Daneel Patoli, Husam Alghanem, and Avery Tung.
• Department of Anesthesia and Critical Care, University of Chicago Hospitals, Chicago, IL. Electronic address: Daneel.patoli@uchospitals.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Oct 1; 34 (10): 2827-2829.

AbstractIntramyocardial hematomas are a rare complication of myocardial infarctions. Normally restricted to the left ventricle, in certain scenarios, such as after a percutaneous coronary intervention, intramyocardial hematomas also can occur in the left atrium. Herein, the case of a 74-year-old man who presented to the authors' institution with a large inferior wall myocardial infarction refractory to multiple pressor therapy and thus necessitated venoarterial extracorporeal membrane oxygenation support is described. Through the course of his hospital stay, the patient developed a large left atrial intramyocardial hematoma obstructing mitral inflow as seen on intraoperative transesophageal echocardiography. Ultimately, because of the patient's complex comorbid status, his case was managed conservatively. In this E-challenge, the reason for the conservative approach and the alternative approach of surgically draining the intramyocardial hematoma are discussed.Copyright © 2020 Elsevier Inc. All rights reserved.

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