PMC10073711_01
Serial ECGs. The pattern of ECGs was persistent, including atrial fibrillation, right axis deviation, poor R-wave progression, profound STE in leads II, III, and aVF with the presence of reciprocal ST depression in the precordial leads. (A) On admission. (B) 1 h later. (C) Before discharge.
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F1
A 12-lead ECG showed rapid atrial fibrillation, and significant convex STE in leads II, III, and aVF with the presence of reciprocal ST depression in the precordial leads (Figure 1A). On serial ECGs, STE persisted and there was no development of pathological Q waves (Figures 1B, C).
Transthoracic two-dimensional echocardiography (2D-TTE). 2D-TTE reveals two large heterogeneous masses characterized by ill-defined borders: one involving the lateral, inferior and posterior portions of the left ventricular wall (white arrowheads), and another involving the apex and ventricular septum (white arrows). (A) Parasternal long-axis view. (B) Four-chamber view. (C) Two-chamber view. (D) Parasternal short-axis view at the papillary muscle level. (E) Modified four-chamber view. (F) RV-focused apical four-chamber view.
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F2
TTE unveiled two large heterogeneous masses, which were characterized by ill-defined borders: one involved the lateral, inferior and posterior portion of the left ventricular wall, and another involved the apex and ventricular septum portion (Figure 2).
Cardiac magnetic resonance and thoracic computed tomography were obtained 6 months after completion of chemoradiotherapy. CMR: (A to D) Tumors of the interventricular septum (white arrows) and inferior-lateral left ventricular wall (white arrowheads) do not demonstrate enhancement on short-axis first-pass perfusion images (A & B) and axial post-contrast T1-weighted images (C) suggestive of necrosis. These lesions demonstrate restricted diffusion on the axial diffusion-weighted images (DWI) (D). (E) No abnormal thickening of the esophageal wall is seen on the mediastinal window (white arrows). (F) Tumors of the interventricular septum and inferior-lateral left ventricular wall invade the left anterior descending (LAD) artery (yellow arrows) and left circumflex (LCx) artery (yellow arrowheads), respectively. These lesions also extend to the pericardium (white arrows). (G & H) Metastatic nodules in the upper lobe of the left lung and the middle lobe of the right lung are seen on the lung window (white arrows).
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F3
The adjacent pericardium was irregularly thickened (Figure 3F). These lesions were new in comparison with the pre-treatment film (Figure 4C). The ESCC was significantly diminished, and there was no longer abnormal esophageal wall thickening (Figures 4A, B; Figure 3E). On lung window, two new well-defined solid nodules in the left upper lobe and the right middle lobe were detected (Figures 3G, H) compared to before treatment (Figure 4D). In addition, the tumors appeared to have restricted diffusion on the diffusion-weighted imaging (DWI) (Figure 3 A to D).
The thoracic computed tomography and histopathology before treatment strategy for esophageal squamous cell carcinoma. (A & B) The sagittal and axial planes demonstrate that the upper esophageal tumor does not invade the surrounding structures (white arrows). (C) The mediastinal window demonstrates normal thickness and density of ventricular and atrial walls. (D) No parenchymal lesions are seen on the lung window. (E) Hematoxylin and eosin-stained esophageal tissue at 400 x magnification showed tumor cells that possess enlarged, hyperchromasia, coarse nucleus; visible nucleoli and large cytoplasm. The tumor cells demonstrate disarray and loss of polarity in the desmoplastic stroma.
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F4
These lesions were new in comparison with the pre-treatment film (Figure 4C). The ESCC was significantly diminished, and there was no longer abnormal esophageal wall thickening (Figures 4A, B; Figure 3E). On lung window, two new well-defined solid nodules in the left upper lobe and the right middle lobe were detected (Figures 3G, H) compared to before treatment (Figure 4D).