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We report the case of an 86-year-old man referred for abdominal pain and ECG signs of inferior myocardial infarction. Transthoracic, transoesophageal and contrast echocardiographs showed a septal intra-mural haematoma, dissecting the right ventricle wall and partially obliterating the right ventricle lumen. A patent communication with left ventricle with extensive wall thrombosis was present at Doppler examination within dissecting haematoma. Although the patient refused any surgical treatment, a 3-month follow-up was uneventful.