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A 67 year old man was transferred because of an acute inferior myocardial infarction with thrombolytic treatment. A thallium 201 myocardial scan revealed partially reversible defects in the right coronary artery (RCA). The angiogram performed seven days after the onset of myocardial infarction showed critical tubular narrowing at the distal RCA and a normal left coronary artery. Balloon angioplasty was successfully performed at the distal RCA with < 30% of residual narrowing of the target lesion site (A, solid arrow); the proximal reference site appeared nearly normal (A, dotted arrow). An intravascular ultrasound (IVUS) study following balloon angioplasty showed an open target lesion site but also an intramural haematoma with lumen compromise (lumen area 5.6 mm2 and minimal lumen diameter (MLD) 2.1 mm) (C, arrowhead) at the proximal reference site (A, dotted arrow). A follow up coronary angiogram performed six months after the balloon angioplasty showed a patent target lesion and proximal reference site (B). The IVUS study performed at this time showed an enlarged lumen area of 11.3 mm2 and an MLD of 3.6 mm, and complete absorption of the intramural haematoma which compressed the lumen of the proximal reference site following balloon angioplasty (D). IVUS study of the proximal reference segment without the intramural haematoma showed a lumen area of 14.6 mm2 and an MLD of 4.2 mm following balloon angioplasty, which had reduced to 12.5 mm2 and 3.7 mm, respectively, at six months follow up.