PMC8118503_01
EKG showing early repolarization in anterior leads and diffuse T wave depression in multiple leads
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EKG showed ST changes consistent with early repolarization in anterior leads and diffuse T wave depression in multiple leads. (Figure 1) Further workup showed the patient had maximum elevated troponin of 34 ng/L.
Coronary CTA showing a filling defect at the right coronary sinus (black arrow) at the level of the right coronary artery ostium suggesting thrombus occluding the proximal right coronary artery (A, B) and normal left coronaries (C,D)
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Patient underwent coronary computed tomography angiography (CTA) for evaluation of his coronaries which showed a filling defect at the right coronary sinus at the level of the right coronary artery ostium suggesting thrombus in occluding the proximal right coronary artery (RCA). (Figure 2) Subsequent left heart catheterization revealed RCA had subtotal occlusion with filling defect at proximal segment consistent with acute thrombus. (Figure 3) The lesion was treated with balloon angioplasty and stenting with excellent results.
Left heart catheterization showing normal left coronary artery (A,B) and sub-total occlusion of right coronary artery with filling defect at proximal segment (white arrow) consistent with acute thrombus (C). The lesion was treated with balloon angioplasty and stenting with excellent results (D)
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Patient underwent coronary computed tomography angiography (CTA) for evaluation of his coronaries which showed a filling defect at the right coronary sinus at the level of the right coronary artery ostium suggesting thrombus in occluding the proximal right coronary artery (RCA). (Figure 2) Subsequent left heart catheterization revealed RCA had subtotal occlusion with filling defect at proximal segment consistent with acute thrombus. (Figure 3) The lesion was treated with balloon angioplasty and stenting with excellent results.
CTA of lungs showed moderate-sized filling defects in the left lower lobe consistent with pulmonary embolism (asterisk *)
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CTA of lungs showed moderate-sized filling defects in the left lower lobe consistent with pulmonary embolism. (Figure 4) D-dimer in this admission was 6,880 ng/ml, which was markedly elevated compared to his previous admission.