PMC9775277_01
Clinical CT scan and ultrasound imaging. (A-F) Enhanced CT scan revealed (A) splenic infarction and splenic artery thrombosis, as well as (B) left renal artery embolization, (C) left renal infarction, and (D) superior mesenteric artery thrombosis and right renal infarction. Ultrasonography of the lower limb artery revealed (E) right popliteal artery thrombosis and (F) left posterior tibial artery thrombosis. (G,H) The attached thrombus (size 1.13 x 1.77 cm and area 1.72 cm2) was observed in the apex part of the LV.
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F1
Fundus examination (Supplementary Figures 1A,B) showed vitreous hemorrhage on the right eye, macular edema on the left eye, and skin pigmentation on both lower limbs (Supplementary Figure 1C), which indicated long-term diabetic lesions with retinopathy and dermopathy. Enhanced computed tomography (CT) scan of the abdomen and the pelvis of the patient revealed splenic infarction and splenic artery thrombosis (Figure 1A), as well as left renal artery embolization (Figure 1B), bilateral renal infarction (Figures 1C,D), and superior mesenteric artery thrombosis (Figure 1D). Ultrasonography of the lower limb artery revealed the bilateral popliteal artery and left posterior tibial artery thrombosis (Figures 1E,F). Furthermore, echocardiography showed abnormal ventricular wall motion with LVT (size of 1.13 x 1.77 cm and area of 1.72 cm2) at the apex to the inferior part (Figures 1G,H; Supplementary Video 1).
Twelve-lead ECG findings on admission. The following ECG findings were observed: sinus rhythm; Q waves in the II, III, and aVF leads; the Q waves of the inspiratory phase became shallow but still existed; poor R-wave progression in chest leads; and T-wave inversion in leads V2 to V5.
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Clinical imaging. (A-C) A coronary CT scan showed that the proximal anterior descending artery had severe calcification and stenosis. (D) Cardiac magnetic resonance imaging revealed delayed enhancement on the apical septal and inferior walls, which presented transmural MI. (E) Cardiac magnetic resonance imaging confirmed the presence of a thrombus at the apex. (F) Resting myocardial radionuclides showed transmural MI and blood perfusion decrement.
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The coronary CT scan showed that the proximal anterior descending artery had severe calcification and stenosis (Figures 3A-C). Subsequent cardiac magnetic resonance imaging confirmed the presence of an apical aneurysm with mobile thrombus at the apex and transmural MI on the apical septal and inferior walls (Figures 3D,E). Resting myocardial radionuclides showed transmural MI in the apical segment of the left ventricle and apical septal segments [approximately 7% of the left ventricular (LV) wall], and blood perfusion was decreased in the inferior wall of the left ventricle (Figure 3F).
Coronary angiography and percutaneous coronary intervention. (A) Left coronary angiography. (B) Right coronary angiography. (C) Before stent. (D) Two drug-eluting stents were implanted in the LAD to achieve revascularization.
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Because the coronary angiography suggested triple vessel disease, percutaneous transluminal coronary angioplasty (PTCA) was conducted, and two drug-eluting stents were placed in the left anterior descending coronary artery (LAD) (Figure 4).