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Coexistent left ventricular clot and self-contained pericardial haematoma: An unusual combination found in a patient post inferior ST-elevation myocardial infarction

The discovery of a left ventricular (LV) thrombus in combination with a pericardial haematoma is a rare occurrence secondary to a complicated myocardial infarction (MI). A 53-year-old male was brought to our emergency in an unresponsive state with unstable haemodynamics. Electrocardiogram showed inferior and right ventricular ST-elevation MI. The patient underwent primary percutaneous coronary intervention of the right coronary and right posterior descending arteries. Echocardiography revealed a mobile clot in the LV apex, secondary to subacute myocardial rupture, and a self-contained pericardial haematoma. Therapeutic subcutaneous enoxaparin was commenced for the LV clot. Changes in the size of the haematoma and LV clot were monitored through serial echocardiographies. The patient underwent an uneventful course where there was gradual dissolution of the clot and resolution of the haematoma. This case illustrates the clinical dilemma of administering anticoagulation for LV clot in the presence of a self-sealed haematoma that could have otherwise resulted in cardiac tamponade and LV wall rupture.