PMC5585549_01
An electrocardiogram (ECG) showed complete right bundle branch block and ST-segment depression in II, III, aVF, and V2 to V6 on admission. ST-segment depression had disappeared when an ECG was redone 4 h later.
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ST-segment depression in II, III, aVF, and V2 to V6. ST-segment depression had normalized in ECG redone 4 hours later (Figure 1).
Magnetic resonance imaging (MRI) and angiography (MRA). (a) Diffusion-weighted image (DWI) on admission showed a high intensity lesion in the watershed area of the right anterior and middle cerebral arteries. (b) Fluid attenuated inversion recovery (FLAIR) on admission showed a high intensity lesion in the same area as the DWI. In addition, there were some other high intensity lesions in the deep white matter that reflected old lacunar infarctions. (c) MRA showed the stenosis of the distal portion of the right middle cerebral artery (arrowhead). (d) On the 51st day after onset, a DWI showed that the lesion was still high. (e) FLAIR on the 51st day after onset showed some of the new lesions became very low. (f) MRA on the 51st day after onset showed stenosis of the same portion of the right middle cerebral artery (arrowhead). ((a), (b), and (c)) On admission. ((d), (e), and (f)) 51 days after onset.
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A magnetic resonance angiography showed stenosis of the distal portion of right middle cerebral artery (Figure 2).
The computed tomography (CT) showed a mass in the small intestine with heterogeneous enhancement. A curative surgery was performed on the 21st day of admission. The tumor had adhered to the retroperitoneum because of localized peritonitis. The tumor size was 60 x 58 x 55 mm. ((a), (b)) Plain CT ((a) axial view, (b) coronal view). ((c), (d)) Enhanced CT ((c) axial view, (d) coronal view). (e) Gross appearance of the resected mass. (f) sections of the mass. Scale bar = 1 cm.
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Computed tomography (CT) showed a mass in the small intestine with heterogeneous enhancement, surrounded by mesenteric fat with hyperdensity indicating localized peritonitis (Figures 3(a)-3(d)). The tumor size was 60 x 58 x 55 mm (Figures 3(e) and 3(f)).
Clinical course.
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The clinical course of the patient is summarized in a scheme (Figure 4).