PMC7487790_01
Twelve-lead electrocardiogram on admission. The electrocardiogram demonstrates hyperacute T waves in V2-4
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Fig1
T waves in V2-4 leads (Fig. 1). Transthoracic echocardiography showed akinesis of the left ventricular anteroseptal-apical wall.
Left coronary angiography. a Initial left coronary angiography of cranial view revealing embolic obstruction straddling the bifurcation in the left anterior descending artery and diagonal branch (arrow). b Left coronary angiography after aspiration showing the restoration of blood flow
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Fig2
CAG revealed emboli straddling the bifurcation between the left anterior descending artery and diagonal artery (Fig. 2a). Aspiration was performed with a Thrombuster II catheter (KANEKA Medix Corporation, Osaka, Japan) retrieving a substantial amount of organized material, after which Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow was achieved (Fig. 2b).
Histopathological findings. a Retrieved embolus. b, c Hematoxylin and eosin staining revealed atypical urothelial cell proliferation
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Fig3
Histopathological analysis revealed that the emboli originated from an UTUC (Fig. 3a-c).
Contrast-enhanced computed tomography showed that tumor invading the left renal vein (arrow)
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Fig4
Contrast-enhanced CT showed tumor invasion to the left renal vein (Fig. 4) and no lung metastasis.
Transesophageal echocardiography showing a patent foramen ovale and shunt flow (arrow). LA: left atrium, RA: right atrium
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Fig5
To examine the intracardiac shunt, we performed transesophageal echocardiography, which confirmed a patent foramen ovale (PFO) (Fig. 5).
Transthoracic echocardiography on readmission showing right ventricular dilatation and a mobile mass attached to the tricuspid valve (arrow). RV: right ventricle, LV: left ventricle, RA: right atrium
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Fig6
Transthoracic echocardiography showed right ventricular dilatation and a mobile mass attached to the tricuspid valve (Fig. 6), which suggested that the dyspnea was caused by a pulmonary artery embolism.