PMC6341272_01
Transthoracic echocardiography, apical 4-chamber views, and multiple pedunculated 2-3 cm echodensities in the right and left ventricles consistent with intracardiac thrombi (a-d): moderate left ventricular hypertrophy (a), borderline LV dilatation (b), right ventricle appears moderately dilated (c), and intra-atrial septal deviated to the left (d). There is a small pericardial effusion.
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Transthoracic echocardiogram showed severe global hypokinesis, moderate-to-severe systolic dysfunction, paradoxical septal motion, and multiple biventricular pedunculated mobile echodensities (about 2-3 centimeters in size) consistent with thrombi with trace pericardial effusion (Figure 1).
A contrast-enhanced chest computed tomography with pulmonary embolism protocol: large filling defect within the distal right lobar pulmonary artery, with thrombus extending into the right lower lobe branches (white arrow). The heart is markedly enlarged with a moderate pericardial effusion. Bibasilar consolidations and areas of linear atelectasis versus scarring/fibrosis at both lower lobes. Bilateral pleural effusions, larger on the right than the left. There is no pneumothorax or pneumomediastinum.
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fig2
Contrast-enhanced pulmonary embolism (CTPE) study revealed right lobar pulmonary embolus and bilateral small pleural effusions (Figure 2).
A computed tomography angiogram of bilateral lower extremity: severe occlusive bilateral superficial femoral arteries at the level of the mid thighs and occlusion of the right internal iliac artery. Mild reconstitution is seen on the right side anterior tibial artery with no flow in it seen distal to the ankle. No reconstitution is seen on the left side. No radiographic evidence of collateralization.
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fig3
Lower extremity computed tomography angiogram (CTA) revealed bilateral occlusion of the superficial femoral, popliteal, posterior tibial, peroneal, and anterior tibial arteries (Figure 3).
Contrast-enhanced cardiac MRI: contrast late enhancement study shows diffuse patchy contrast late enhancement mostly involving mid- and epicardial layer of myocardium, more at the midlateral wall and inferior wall which can be consistent with myocarditis. Small pericardial effusion.
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Contrast-enhanced cardiac MRI revealed diffuse patchy late enhancement of the epicardial layer of the myocardium and small pericardial effusion consistent with perimyocarditis (Figure 4).