PMC7093383_01
(A) Electrocardiogram on admission showing ST-segment elevation in the precordial leads. (B) Electrocardiogram after percutaneous coronary intervention showing significantly improved ST-segment elevation resolution.
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F1
His electrocardiogram showed ST-segment elevation in the precordial leads (Figure 1A). Few hours later, another electrocardiogram showed significantly improved ST-segment elevation resolution (Figure 1B), and the index echocardiogram (Figure 2D) showed the hypokinesis of LV apical wall which was consistent with the territory supplied by the distal LAD, left ventricular (LV) apical thrombus (13 mm x 13 mm), thickened LV septum (12-14 mm), and a borderline LV ejection fraction (50%).
(A) Coronary angiogram revealing patent right coronary artery (RCA). (B) Coronary angiogram revealing minimal stenosis of <30% near proximal left anterior descending coronary artery (LAD) and occlusive thrombus in distal LAD. (C) Recovery of antegrade flow into distal LAD after manual thrombus aspiration. (D) Index echocardiogram revealing left ventricular (LV) apical thrombus. (E) Computed tomography scan revealing right adrenal mass which is of soft tissue attenuation with heterogeneous contrast enhancement. (F) Echocardiogram performed at the 2-month follow-up revealing left ventricular (LV) apical aneurysm.
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F2
After the procedure, the flow of the distal LAD achieved TIMI grade 2, and the lumen size recovered to the normal level (Figure 2C). Few hours later, another electrocardiogram showed significantly improved ST-segment elevation resolution (Figure 1B), and the index echocardiogram (Figure 2D) showed the hypokinesis of LV apical wall which was consistent with the territory supplied by the distal LAD, left ventricular (LV) apical thrombus (13 mm x 13 mm), thickened LV septum (12-14 mm), and a borderline LV ejection fraction (50%). Contrast-enhanced computed tomography scan showed a large mass (9.4 cm x 7.3 cm x 8.8 cm) arising from the right adrenal gland which is of soft tissue attenuation with heterogeneous contrast enhancement (Figure 2E). At the 2-month follow-up, his blood pressure was well-controlled; and the repeated echocardiogram showed the disappearance of LV thrombus, persistent hypokinesis of the LV apical wall, and medium-sized LV apical aneurysm (23 mm x 14 mm; Figure 2F).