PMC6307365_01
Contrast-enhancement computed tomography scan showing (A and B) pleural effusion, (C) right abdominal cavity effusion and (D) pelvic effusion and exudative lesions of the soft tissues surrounding the right groin and thigh.
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Abdominal and chest computed tomography (CT) revealed a markedly swollen right lumbar muscle, exudative lesions of the soft tissues surrounding the right groin, right thigh and right abdominal cavity, retroperitoneal and pelvic effusion, and right massive pleural effusion with incomplete expansion of the right lung (Fig. 1).
(A) Color doppler ultrasonography showing mild mitral valve reflux. (B) Tissue doppler imaging showing tricuspid valve regurgitation, high pulmonary artery systolic blood pressure and reduced diastolic left ventricular function. The parameters of cardiac function were as follows: Right ventricular internal dimension in diastole, 26.1 mm; intraventricular septum in diastole, 7.6 mm; left ventricular internal dimension-in diastole, 43.1 mm; left ventricular posterior wall dimension, 7.6 mm; left ventricular internal dimension in systole, 23.4 mm; heart rate, 84 bpm; aorta, 23.1 mm; left atrium, 32.5 mm; fractional shortening, 45.7%; ejection fraction, 77.4%).
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Mild mitral valve reflux and tricuspid valve regurgitation, high pulmonary artery systolic blood pressure, and reduced diastolic left ventricular function were observed on heart doppler ultrasonography (Fig. 2).
Thromboelastography showing a prolonged R-time (35.8 min) and K-time (15.3 min), a narrowed angle (35.2 ), decreased MA (44.5 mm), decreased CI (-28.8) and normal clot lysis, which is reported in terms of EPL (0.0%) and LY30% (0.0%). R, reaction time; K, coagulation time; deg, degree; MA, maximum amplitude; CI, coagulation index; EPL, estimated percent lysis; LY30%, percent clot lysis at 30 min after maximum amplitude; A, amplitude.
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The following were observed by thromboelastography (TEG): Reaction time (time from the start of the test to initial fibrin formation), 35.8 min (normal range, 5.0-10.0 min), coagulation time (time required for clot formation), 15.3 min (normal range, 1.0-3.0 min), angle (measurement of clot growth), 35.2 (normal range, 53.0-72.0 ), maximum amplitude (measurement of clot strength), 44.5 mm (normal range, 50.0-70.0 mm) and coagulation index, -28.8 (normal range, -3.0-3.0; Fig. 3).