A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Computed tomography-derived fractional flow reserve (FFRct) report. Numbers indicate FFRct readings 15 mm distal to the stenoses in the left main (LM) coronary artery and right coronary artery (RCA), respectively, corresponding to the blue arrows in Figure 1. The FFRct value was <=0.75 in the distal LM, proximal left anterior descending coronary artery, and proximal left circumflex coronary artery, whereas it was 0.86 in the ramus. The FFRct value in the RCA was normal.


A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Invasive coronary angiography. Left: Right coronary artery which is without coronary stenosis. Right top: Left anterior descending coronary artery with moderate elongated stenosis (red arrow). The ramus and left circumflex coronary artery are without coronary stenosis. Right bottom: Left main coronary artery with distal moderate stenosis (red arrow). Blue arrow: Points of FFR measurements.


(A) Transabdominal scan performed at 25 weeks 4 days in coronal plane: the cleft lip appeared as an anhecogenic area at the level of the left upper lip.


(B) Transverse section of fetal chest at 25 weeks 4 days: the red arrow pointed to the defect between the left atrium (LA) and the coronary sinus (CS).


(C) The three-vessel and tracheal (3VT) view at the upper mediastinum showed a supernumerary vessel to the left of the pulmonary trunk and arterial duct. The red arrow pointed to the persistent left superior vena cava (PLSVC) draining into the right atrium.


Single nucleotide polymorphism (SNP) array results of the fetus: the red rectangle showed the deletion region of 1q23.3q31.2.


A chest computed tomographic image in the axial plane demonstrates ground-glass opacities of the lung parenchyma with bilateral and sub-pleural distribution admixed with areas of focal consolidation.


A cardiac catheterization image evidences the progression of the dissection until the circumflex artery after percutaneous coronary intervention (PCI).


Coronary angiography and cerebral CT. Coronary angiography showed a total occlusion at the mid-left anterior descending branch (red arrow). (A) Cranial view.


Coronary angiography and cerebral CT. Coronary angiography showed a total occlusion at the mid-left anterior descending branch (red arrow). (B) Left cranial view.


Coronary angiography and cerebral CT. Coronary angiography showed a total occlusion at the mid-left anterior descending branch (red arrow). (C) Axial cerebral CT showed hypodensity in the right parietooccipital lobe, with two spotted hyperdense areas.


(a) Photomicrograph of the tumor showing distinctly two populations of cells, one of a high-grade glial cell types showing marked nuclear pleomorphism and multinucleated tumor giant cells merging with bundles of malignant spindle-shaped cells (H and E, x250). (b) Photomicrograph showing selective cells stained positive for glial fibrillary acidic protein (PAP, x450). (c) Photomicrograph showing vimentin positivity by both types of tumor cells ie, spindle-shaped cells and malignant glial cells with bizarre nuclei (PAP, x450).


EKG showing early repolarization in anterior leads and diffuse T wave depression in multiple leads.


Coronary CTA showing a filling defect at the right coronary sinus (black arrow) at the level of the right coronary artery ostium suggesting thrombus occluding the proximal right coronary artery.


Normal left coronaries.


Left heart catheterization showing normal left coronary artery.


Sub-total occlusion of right coronary artery with filling defect at proximal segment (white arrow) consistent with acute thrombus.


The lesion was treated with balloon angioplasty and stenting with excellent results (D).


CTA of lungs showed moderate-sized filling defects in the left lower lobe consistent with pulmonary embolism (asterisk *).


Electrocardiogram findings in the studied case. (a) Before treatment.


Electrocardiogram findings in the studied case. (b) After treatment.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. B; The distal end of the PED was deployed proximal to the distal end of the previous Enterprise stent. C Dyna-CT indicated that the entire PED was deployed within the Enterprise.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. D; Adjunctive coiling was performed to secure the aneurysm.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. Right anterior oblique.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. Lateral view. Of DSA indicated complete occlusion of the aneurysm on follow-up 6 months later.


Serial ECGs recorded during hospitalisation.


(A) In chest X-ray, permeability was reduced in bilateral lower lung field and butterfly shadow was observed. Cardio-thoracic ratio (CTR) was 59.8% and both costophrenic angles (CPA) were blunt.


(B) Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver. The right adrenal gland showed round shape and a mixture of high- and low-density area. In addition, since there was thin adipose tissue between the right adrenal gland and the kidney and inferior vena cava, there seemed to be no infiltration into surrounding organs.


(C) In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver, and there was small hot spot in the sternum and right rib.


Intimal dissection (arrow) in proximal left anterior descending artery (LAD) by coronary angiography.


Entry (arrow) of intimal tear of the proximal to dissection site in the LAD by intravascular ultrasonography (IVUS).


Intimal flap (arrow) dividing between true lumen, and ,false lumen in the dissection site by IVUS.


Re-entry (arrow) of intimal tear of the distal to dissection site by IVUS.


Coronary angiography revealing intimal dissection (arrow) in mid left anterior descending artery.


Immediate poststenting coronary angiography.


Intimal flap (arrow) dividing between true lumen, and ,false lumen in the dissection site by intravascular ultrasonography (IVUS).


Entry (arrow) of false lumen site in the dissection site by IVUS.


(a) Two-dimensional transthoracic apical four-chamber zoom view focusing the posterobasal ventricular septal defect.


(b) Two-dimensional transthoracic apical four-chamber view on color Doppler shows the left-to-right shunt.


(c) Three-dimensional transthoracic apical four-chamber view images show ventricular septal defect and allow its sizing.


Fluoroscopic images before.


After. Implantation of a 26-mm Amplatzer atrial septal occluder.


Two-dimensional transthoracic apical four-chamber view images acquired 6 days after percutaneous closure: a 26-mm Amplatzer atrial septal occluder correctly placed.


Mild residual interventricular shunt on color Doppler.


Postnatal cranial ultrasound images showing bilateral intraventricular hemorrhage with extensive hemorrhagic infarction of the left hemisphere and ventricular dilatation in coronal view.


Parasagittal left plane view.


Blood clot in the 4th ventricle.


Dilatation of the 4th ventricle (*) with dysplastic cerebellar hemispheres.


Postmortem magnetic resonance imaging showing extensive ventricular dilatation and blood in the 4th ventricle in T2-weighted midsagittal plane , intraventricular blood in the right ventricle.


Ventricular dilatation of the left ventricle in T2-weighted axial plane.


Blood in the 4th ventricle with cerebellar dysplasia in T2-weighted axial plane.


Susceptibility weighted image axial plane. Of the posterior fossa.


Histologic presentation of case 1. Endomyocardial biopsy shows interstitial fibrosis with some interstitial lymphocytes. Signs of hypertrophy are detectable.


EKG showing sinus tachycardia with q waves and ST segment elevations of almost 2 mm in leads III and aVF (arrow) along with ST segment depressions in I and aVL leads. This implies that there is possible inferior wall infarction. Left atrial enlargement also noted.


Echocardiogram with color Doppler displaying a ventricular septal defect postmyocardial infarction (arrow).


Transesophageal echocardiogram showing ventricular septal defect (arrow) with size.


3D echocardiogram showing ventricular septal defect (red arrow) and necrosis (black arrow).


(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.


(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.


Baseline electrocardiogram showing pre-excitation.


Echocardiography before ablation showing dilation of left ventricle and dysynchrony between septal and lateral wall on the apical four chamber view.


Electrocardiogram after ablation showing normal PR segment.


Echocardiography post ablation showing synchrony between the septal and lateral wall in the apical four chamber view.


A venacavagram performed during IVC filter placement demonstrating filling defect near the confluence of the common iliac veins.


With delayed reconstitution of contrast flow into the right, but not left, common iliac vein Findings are consistent with an occlusive thrombus in the left common iliac vein with extension into the proximal IVC which is near-occlusive in nature.


(a) Sagittal T1-weighted MR sequence revealing a lesion in the L5-S1 anterior epidural space that is heterogeneously hypointense (arrow).


(b) Sagittal T2-weighted MR sequence with anterior spinal epidural lesion that is mixed iso- and hyperintense centrally with a rim of hypointensity peripherally (arrows), most prominently seen at L4-S1 but also present at T12-L3 levels. There is evidence of mass effect with compression of the thecal sac.


Sagittal.


Axial. Images of gadolinium-enhanced T1 MR sequence. Arrows depict heterogeneous contrast-enhancing lesions in the anterior epidural space that have serpiginous fill void centrally.


Electrocardiogram after admission to our hospital.


ECG ST elevation in the anterior leads (v1-v4. ).


Coronary angiogram (2a. patent Right coronary artery (RCA), 2b. red arrow: thrombosed LAD, 2c. blue arrow: LAD post stenting).


12 lead electrocardiogram showing ST-segment elevation at V3-V4 with reciprocal changes at lead II and III.


Coronary angiography at the time of her presentation at the outline hospital. (a) Severe stenosis at mid right coronary artery.


Coronary angiography at the time of her presentation at the outline hospital. (b) Repeat angiography after nitroglycerin infusion with near complete resolution of the right coronary artery stenosis.


Coronary angiography at the time of her presentation at the outline hospital. (c) Moderate-severe stenosis at proximal left anterior descending artery.


Coronary angiography at the time of her presentation at the outline hospital. (d) Repeat angiography after nitroglycerin infusion with near complete resolution of the left anterior descending coronary stenosis.


Cardiac magnetic resonance imaging, (a) Mid ventricular short axis slice demonstrating transmural infarct (red arrows) of the anterior septum with evidence of microvascular obstruction (white arrows) on delayed gadolinium.


(b) Two-chambers view showing transmural infarction (red arrows) of the anterior septum with evidence of microvascular obstruction (white arrows) delayed gadolinium.


Electrocardiogram on admission shows sinus rhythm, complete right bundle branch block, pathological Q waves in leads V1-V3, and T wave changes in some leads.


Color Doppler echocardiography shows left ventricular apical aneurysm formation and left ventricular systolic and diastolic dysfunction.


Left ventricular angiography using a pigtail catheter shows ventricular aneurysm formation.


Timeline showing the clinical course in this patient.


Electrocardiogram at admission.


Electrocardiogram at 24 hours after admissionn.


Electrocardiogram at 2-months follow-up.


Coronary angiography at 2-months follow-up - normal left coronary artery.


Magnetic resonance imaging at 2-months follow-up - dynamic postcontrast T1 sequence with moderate focal capture in the septal myocardium (arrows).


A pre-operative electrocardiogram showed sinus rhythm with a heart rate of 75 beats per minute and p mitrale (noted by the negative q wave deflection of more than 1 mm in the lead V1, suggestive of left atrial enlargement).


Computed tomography angiography. A. Compression of the left common iliac vein between the right common iliac artery and lumbar spine.


Computed tomography angiography. B. Normal left common iliac vein.


Initial venography, a. MTS. Synechias endoluminal of the left common iliac vein.


B. Normal left common iliac vein.


Dissection of the right internal carotid artery, which was the etiology for amaurosis fugax. This is noted as a string sign, representing the extent of the dissection.


Dissection of the right internal carotid artery is noted in a transverse view.


Heart, anterior surface - cardiomegaly, aneurysmal dilatation A distal to the left subclavian artery, anomalous collaterals (arrow) distal to aneurysm.


Heart, posterior surface -constriction beyond aneurysm A. Descending thoracic aorta DTA is supplied by bunch of anomalous collateral arteries (arrows). The ductus is closed. AA: Ascending aorta, LCCA: Left common carotid artery, LA: Left atrium, LPA: Left pulmonary artery, LV: Left ventricle, PT: Pulmonary trunk, RAA: Right atrial appendage, RBCA: Right brachiocephalic artery, RPA: Right pulmonary artery, RV: Right ventricle.


Heart ultrasound showing right coronary artery aneurism (RCA).


Summary of main data regarding the whole clinical history.


Summary of main inflammatory markers tested during the disease course and how they have been influenced by the different therapies.


Computed Tomography and Histological Images of the Pheochromocytoma. A: Abdominal computed tomography showing a left adrenal mass of 50 mm in diameter with rounded, well-defined edges, and hyperdense areas of cystic necrosis inside (asterisk).


Computed Tomography and Histological Images of the Pheochromocytoma. B: Histological panoramic view of the pheochromocitoma. On the left side of the picture there is a normal adrenal gland on which sits the tumor with a large nodule with areas of hemorrhagic aspect, especially in the tumor periphery.


Coronary angiogram in the left anterior oblique caudal view showing in-stent restenosis in the left anterior descending stent.


Coronary angiogram in the right anterior oblique caudal view showing in-stent restenosis in the left anterior descending stent.


Final result poststenting in the left anterior oblique caudal view.


The CAG showed the severely dilated left sinus of Valsalva and the contrast agent was preserved and rotated in a circle (A).


The aneurysm compressed the LMCA (yellow arrow) in the upward direction with significant LMCA seriously narrowing (B). No critical stenosis was observed in LAD. Red stars, the outline of the SoVA; CAG, coronary artery angiography; LMCA, left main coronary artery; LAD, left anterior descending coronary artery, black arrow; white arrow, left circumflex coronary artery.


Angiography showing total occlusion of the three vessels with distal flow in dorsalis pedis artery from collaterals.


Intravenous cannula at the dorsum of the foot.


Guidewire inside the dorsalis pedis artery.


Medical image.


Final angiogram.


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (A) 2D-TTE parasternal long axis view with indicating the prolapsed left atrial myxoma during systole (enveloped by the white, elliptical border).


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (B) Transesophageal view of the atrial myxoma (subtended by the white curvilinear line).


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (C) 2D-TTE parasternal long axis view illustrating the pseudo-stenotic, obstructive effect of the atrial myxoma (subtended by the white curvilinear) of both the mitral valve orifice and left ventricular outflow tract.


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (D) 2D-TTE short axis view of the atrial myxoma at the level of the mitral valve and its subvalvular apparatus (enveloped by the white, elliptical border).


Cineangiography series. (A) Left coronary angiography revealing patent left anterior descending and left circumflex arteries (indicated by the black arrows) with thrombolysis in myocardial infarction (TIMI 3) antegrade flow.


Cineangiography series. (B) Right coronary angiography revealing a dominant and patent right coronary with TIMI 3 antegrade flow (indicated by the black arrow).


Resected gross specimen. Histopathology examination of the specimen confirmed the diagnosis of myxoma.


Chest X-ray upon first admission. . Cardio-mediastinal silhouette is within normal limits with the heart being normal in size. . No pleural effusion / pneumothorax/consolidative patches identified.


Chest X-ray upon his most recent admission. . Mildly prominent hilar vascular markings identified (red arrows) with minimal blunting of the left costophrenic angle (blue arrows) and mild elevation of the left hemidiaphragm. But Cardio-mediastinal silhouette.


Chest CT upon recent admission. . Congestive pulmonary changes in the form of ground glass opacities and pleural effusion at the posterior inferior aspects of both lungs, more on the left. (Arrow heads) Circumferential pericardial effusion (red arrow).


Pleural and Pericardial Biopsy Histopathology report. . A. Light microscopic view showing well-defined epithelioid granuloma engulfing parasitic egg (H&E x400).


Pleural and Pericardial Biopsy Histopathology report. . B. The cuticle of the parasitic egg is polarizable (H&E x400 with polarizer/analyzer lens).


Contrast CT scan of the chest. Right apical tumour, with mediastinal extension.


Inferior regional pericarditis.


Severely stenosed coronary arteries in an HoFH patient. (A) Calcified plaques (black arrow) in the middle of the left descending artery in the heart of the patient. Stenosis (red arrow) in the middle of the left descending artery.


Severely stenosed coronary arteries in an HoFH patient. (B) Calcified plaques (black arrow) in the initial ramus. Stenosis (red arrow) in the initial ramus.


Timeline of the patient's entire diagnosis and treatment.


Angiogram showing unobstructed coronary arteries.


Echocardiogram showing single ventricle (arrow) with double inlet etiology.


Invasive Angiography identifying Circumflex Artery Disease.


Electrocardiogram of the patient showing sinus tachycardia and a prolonged QTc.


Electrocardiogram of the patient showing frequent ventricular ectopics and a run of nonsustained ventricular tachycardia.


Computed tomography picture showing renal mass lesion.


Histopathology consistent with Reninoma.


Chest x-ray after intubation showing hyperlucent left hemithorax with mediastinal shift to the contralateral side and flatting of ipsilateral hemidiaphragm.


Foreign body obstructing the trachea at the level of tracheal bifurcation. A right tracheal bronchial orifice is seen.


Foreign body was the eraser part of a pencil (no popcorn pieces).


After removal of foreign body, re-examination revealed a clear airway with confirmed right tracheal bronchus.


Repeated chest x-ray showing satisfactory ETT position and absence of pneumothorax.


Selective right coronary angiography, early phase, the left circumflex artery (LCx) originating from the right coronary artery (RCA).


Late phase of contrast injection to the right coronary artery demonstrated retrograde filling of the left anterior descending coronary artery (LAD) via intramyocardial collaterals and shunting to pulmonary artery.


Resting 12-lead electrocardiogram (EKG) showing ST elevation in the anterior leads V2, V3 and V4.


Coronary angiogram showing coronary artery dissection that starts at the origin of Left Anterior descending artery (LAD) (See the star) and extends down to involve proximal and Mid LAD (See the white arrows).


Coronary angiogram showing occlusion of the proximal branch of the Left anterior descending artery (LAD) (See the white arrow) and an evidence of proximal and Mid LAD dissection (See the black arrows).


Coronary angiogram post percutaneous coronary angioplasty and placement of drug-eluting stent to the left anterior descending artery (See white arrows).


Myocardial biopsy. Congo red staining showed reddish amyloid material in the myocardium.


Myocardial biopsy. With apple-green birefringence under polarised light , x200.


Renal biopsy. Congo red staining showed reddish amyloid material in the renal medulla.


Renal biopsy. With apple-green birefringence under polarised light , x200.


Phenotypic characteristics of Kabuki Syndrome at 18-years-old include eversion of the lower eyekid, enlongates eyelid closurem arched eyebrows, long eyelashes and nasal tip facing down.


Brain Magnetic Resonance Imaging (MRI) in axial contrasted T1.


Medical image.


Flair.


Diffusion Note: There are some artefacts on (d and e) images due to magnetic susceptibility by the dental appliance.


Apparent Diffusion Coefficient Hyperintense T2 lesion on right posterior white matter unattended signal alteration or contrast enhancement on T1 or diffusion restriction. It is a quite unspecific, may suggesting a possible gliosis probably due to another (previous) ischemic injury. Note: There are some artefacts on (d and e) images due to magnetic susceptibility by the dental appliance.


LM and LAD, 40. cranial / 5. RAO view. Femoral approach 5 French catheter.


LM and LAD after intracoronary nitrates, 40. cranial / 5. RAO view. femoral approach 5 French catheter.


PDA of the right coronary artery after intracoronary nitrates, 25. cranial / 35. LAO view. Femoral approach 5 French catheter. The stenosis is unmodified.


PDA of the right coronary artery after stenting, 25. cranial / 35. LAO view. Femoral approach 6 Franch guider catheter.


Right atrial thrombus (center) surrounded by pulmonary thromboendarterectomy specimens.


Hypopyon and track of pus from tube at presentation with endophthalmitis.


The 12-lead electrocardiogram shows ST elevation, contextual Q waves and negative T waves in inferior leads (DII, DIII, aVF) and ST depression in V2-V6.


Preoperative transthoracic echocardiography. Apical two-chamber view shows the midbasal inferior left ventricular aneurysm (a and b).


Preoperative transthoracic echocardiography. Subcostal views show the ventricular septal rupture.


Preoperative transthoracic echocardiography. And the left to right ventricular shunt.


Left ventriculography shows the huge inferior left ventricular aneurysm (An) and the contrast enhanced in the right ventricle (arrow).


Modified apical 4-chamber view, showing the coronary aneurysm in the atrioventricular groove, in connection with the right coronary artery.


The right coronary artery aneurysm showed from subcostal view and its major diameters.


Angiography of the right coronary artery confirming the huge aneurysm; two critical stenoses are visible proximal and distal to the ectasia.


Left coronary artery angiographic image demonstrating a 90% stenosis of mid-left anterior descending artery. This was the culprit lesion responsible for patient's angina and the anteroseptal hypokinesia at echocardiography. A 70% stenosis of proximal left circumflex coronary artery was also detected; this vessel had small caliper and distribution (not showed).


The 12- lead patient's Electrocardiogram.


A) Standard 12-lead electrocardiogram (ECG) at initial presentation, showing an ST-segment elevation in the inferior leads (II, III, and aVF) and leads V3 - V5, along with an ST-segment depression in leads I and aVL.


B) Right precordial lead ECG at initial presentation, revealing an ST-segment elevation in leads V3R-V6R.


C) Posterior precordial leads at initial presentation, showing no significant ST deviation in leads V7 - V9.


Coronary angiograms of the patient: Diffuse critical stenoses (arrows) are seen in the left anterior descending (and the left circumflex arteries in the right anterior oblique (RAO) caudal view.


In the right coronary artery (RCA) in the left anterior oblique (LAO) view.


Noncritical coronary plaques after the intracoronary nitroglycerine injection are seen in the coronary arteries in the ROA views of coronary angiography (C and D).


Left ventriculography in the RAO view shows a good left ventricular size and function (E).


(A) Coronary angiogram of the completely occluded right coronary artery.


(B) Coronary angiogram showing Rentrop grade II collateral flow to the right coronary artery from the left ascending coronary artery.


(A) Coronary angiogram of the right coronary artery flow before cutting balloon dilatation.


(B) Coronary angiogram of the right coronary artery flow after cutting balloon dilatation.


Preoperative chest X-ray.


Preoperative chest computed tomography.


MRI showing the dilation of RV and transmural fibrofatty replacement in the RV free wall.


Two-dimensional echocardiogram short-axis view of the aortic valve showing an aneurysm at the non-coronary sinus of Valsalva measuring 1.94 cm x 2.57 cm. LA, left atrium; RA, right atrium; AV, aortic valve.


Two-dimensional echocardiogram short-axis view of the aortic valve.


With color flow Doppler. Showing a fistula between the non-coronary sinus of Valsalva aneurysm and the RA. LA, left atrium; RA, right atrium; AV, aortic valve; Asterix, sinus of Valsalva aneurysm; RV, right ventricle.


Image demonstrating the non-coronary sinus of Valsalva aneurysm communicating with the RA. RA, right atrium; Asterix, sinus of Valsalva aneurysm.


Panel demonstrating the non-coronary sinus of Valsalva aneurysm form the perspective of the aortic root.


The perspective of the right atrium Asterix, sinus of Valsalva aneurysm-to-right atrial fistulas.


Electrocardiograme demonstrating symmetrical T wave inversions in the anterolateral leads concerning for ischemia.


(A) Coronary angiogram showing left coronary artery circulation with a non-occlusive lesion in proximal left circumflex artery.


(B) Coronary angiogram showing right coronary artery circulation.


(A,B) Left ventriculography demonstrating apical ballooning and hypokinesis of the apex with normal functioning basal inferior and anterior segments.


ECG of the patient on presentation showing inferior ST-elevation myocardial infarction (STEMI) with a lateral extension.


Brain MRI: (A-C) T2, FLAIR and DWI showing right MCA territory infarction. A small chronic ischemic lesion seen in the white matter of the left frontal lobe.


(D) SWI image showing blooming artifacts at the site of infarction representing blood component (hemorrhagic transformation).


Brain CTA showing a Lesser extent of opacification of the cortical branches of right MCA compared to the left.


Transesophageal echocardiogram (TEE) images showing ascending aorta thrombus.


Chest CTA showing non-occlusive filling defects at the origin of the Brachiocephalic artery and in the proximal ascending aorta.


Lumbar Spine MRI:. Sagittal T2WI showing degenerative disc changes with significant thecal sac compression at levels L5-S1.


Magnification X1. Axial T2W at levels L4-L5 showing a massive AAA, Magnification X2. . Abbreviations: AAA, Abdominal Aortic Aneurysm; MRI, Magantic Resonance Imaging.


Preoperative CTA:. Axial view showing a thick-walled 10 cm infrarenal AAA.


Magnification x1 Axial (Magnification X1) and coronal (Magnification X2) views showing an aneurysmal extension into to right IIA. . Abbreviations: AAA, Abdominal Aortic Aneurysm; CTA, Computed Tomography Angiography.


Intraoperative digital subtraction angiogram:. Large infrarenal AAA with aneurysmal dilatation of right common iliac artery, and ,short ectatic left common iliac artery.


Magnification X1 successful deployment of the bifurcated graft and embolization of RIIA, Magnification X1. . Abbreviations: AAA, Abdominal Aortic Aneurysm; RIIA, Right Internal Iliac Artery.


Follow-up CTA showing: (A) patent graft with exclusion of the aneurysm from circulation and without endoleak, Magnification X1.


(B) Retrograde flow into RIIA, Magnification X1. . Abbreviations: CTA, Computed Tomography Angiography; RIIA, Right Internal Iliac Artery.


Ischemic colitis changes seen on a rectal biopsy. Magnification X4.


ECG: SR 60 bpm, negative T waves in V1-V2, QS in V3-V5.


Extensive fibrosis at biventricular level (a, b).


Electrocardiogram showing extensive anterior wall myocardial infarction (evolved).


Left coronary angiogram showing no evidence of significant coronary artery disease.


Photograph showing tendinous xanthomas on the elbow.


Photograph showing tuberous xanthomas on the buttocks.


Left coronary angiogram showing left main coronary artery-ostial 90% discrete stenosis and left anterior descending-proximal 90% discrete stenosis and mid total occlusion.


EKG initial presentation. . Note: An EKG showed a sinus rhythm with a right bundle branch block (RBBB) but without signs of ischemia. . Abbreviation: EKG, electrocardiogram.


Echocardiogram TEE PFO. . Notes: TEE showed a very minor PFO only with a Valsalva maneuver. Doppler views did not demonstrate a PFO (A).


Echocardiogram TEE PFO. . Notes: TEE showed a very minor PFO only with a Valsalva maneuver. During the Valsalva maneuver, a single bubble became apparent (blue arrow) (B). There was no aortic dissection. . Abbreviations: PFO, patent foramen ovale; TEE, transesophageal echocardiogram.


Left heart catheterization. . Note: (A) shows a thrombus in the proximal to mid LAD.


Left heart catheterization. (B) shows the dissolution of the thrombus.


Left heart catheterization. (C) shows recurrence of thrombus from the second cardiac event months later.


Left heart catheterization. (D) shows reperfusion of the vessel after stent placement. The coronary angiography shows a thrombus in the proximal to mid LAD (arrow) in otherwise normal coronary arteries. . Abbreviation: LAD, left anterior descending artery.


EKG second event. . Note: The EKG from the second event showed marked sinus bradycardia with PAC and existing T wave inversions in inferior leads. . Abbreviations: EKG, electrocardiogram; PAC, premature atrial complex.


Coronal image of CT aorta angiogram shows the pooling of contrast into a thin-walled protrusion arising from the anterolateral part of left ventricular wall (thin red arrow) abutting the proximal portion of ascending aorta (solid yellow arrow).


Contrast-enhanced axial CT shows the displacement of left aortic sinus (bold yellow arrow) and left coronary artery (thin red arrow).


Coronal-reformatted CT angiogram image demonstrates a large thrombus in the right atrium (bold red arrow) extending into the superior vena cava (bold yellow arrow).


Stent with inflated balloon along with 26 cm of snapped delivery system, Inset: Balloon in inflated stage, stuck within the stent.


Post-surgery echo of left atrial appendage.


(a) Intraoperative ultrasonography is showing a hypoechoic cystic lesion in left lateral ventricle with another small cystic lesion within this lesion.


(b) Hydatid cyst after excision.


Narrow complex tachycardia suggesting atrioventricular nodal re-entrant tachycardia.


Wenckebach phenomenon seen during a bout of palpitations.


Normal heart rate response during a treadmill exercise test.


The 12-lead electrocardogram (ECG) of the first patient demonstrating tachycardia with QT interval of 440 milliseconds and ST segment elevation in aVR and T wave inversion V1, V2 and V3.


The 12-lead electrocardogram (ECG) of the second patient demonstrating sinus tachycardia and prolonged QT-interval.


Erythematous rash over the left lower limb.


Twelve-lead electrocardiogram results. (A) The first electrocardiogram indicating ST-segment elevation in the II, III and aVF leads (0.5-0.7 mV) with ST-segment depression in the I and aVL leads (0.2-0.4 mV).


Twelve-lead electrocardiogram results. (B) The preoperative electrocardiogram (49 minutes after the first electrocardiogram) indicating ST-segment elevation in the II, III and aVF leads disappeared.


Electrocardiogram showing concave shaped ST- elevation in inferior and lateral leads.


contrast-enhanced computed tomography (CT) scan showed embolic cerebral infraction consisting in multiple supratentorial regions of hypodensity in a vascular distribution occurring in the white matter-gray-matter.


contrast-enhanced computed tomography (CT) scan showed in the cervicothoracic section a thrombosed dissection of left internal carotid.


Coronary angiography showed an acute thrombotic type 1 dissection of the proximal left descending artery with TIMI III blood flow.


Angiogram with right anterior oblique (RAO)-caudal projection of the saphenous vein graft bypassing the first diagonal artery revealing severe spasm (dashed arrow) of the proximal portion of the graft.


Angiogram with RAO-caudal projection depicting resolution of saphenous vein graft spasm (solid arrow) after Intracoronary (IC) administration of nitroglycerin.


Severe stenosis at mid-portion of left anterior descending artery (LAD).


Severe stenosis before last seen lesion.


Stenting of LAD lesion.


Severe stenosis at mid-portion of right coronary artery (RCA).


Severe long stenosis at proximal to mid-portion of RCA.


In the left panels, 12-lead electrocardiogram (ECG)at the age of nine (2002), depicting sinus rhythm, PR interval 160 ms, QTc 380 ms and Q-waves in leads V5, V6 with negative T-waves. In the right panel, 12-lead ECG on admission at the age of sixteen (2009), depicting sinus rhythm; PR interval 130 ms and delayed left atrial depolarization (the second vector of the P-wave is delayed, most likely by fibrosis of the interatrial septum); deep Q-waves in leads I, aVL, V5, and V6, diffuse T-wave inversion, QRS duration 130 ms and different morphologies of fQRS, including various RSR. patterns.


Parasternal large axis view.


Apical four-chamber view. Depicting global thickened of the left ventricular walls and right ventricle and interatrial septum involvement. IVS: interventricular septum; LA: left atria; LV: Left ventricle; RA: right atria; RV: right ventricle.


(A, B) Coronary computed tomography showing normal coronary arteries without stenosis.


Coronary angiography (CAG) at the time of acute coronary syndrome. (A) Complete obstruction of proximal right coronary artery (RCA).


Coronary angiography (CAG) at the time of acute coronary syndrome. (B) Restoration of RCA flow after angioplasty and thrombus suction.


Coronary angiography (CAG) at the time of acute coronary syndrome. (C, D) CAG at the time of recurred angina showing stenosis of distal right coronary artery with aneurysmal change.


Coronary angiography. A. Right anterior oblique and caudal view.


Coronary angiography. B. Left anterior oblique and cranial view. A stent thrombosis is visible (arrowheads) in the in-stent segment of the proximal left anterior descending artery.


Intravascular ultrasound. Fibrous thrombi are visible in the in-stent segment of the pLAD artery.


Aspirated thrombi. A. Several large thrombi (arrow) were aspirated during PCI and preserved in physiologic saline inside the aspiration device.


Aspirated thrombi. B. Extracted thrombi on a Petri dish.


Macroscopic and microscopic features of the ruptured heart. A; The probe passes through the rupture site at the base of the right ventricle. There is significant pericardial hemorrhage. The tricuspid valve is seen centrally.


Macroscopic and microscopic features of the ruptured heart. B; High power photomicrograph of the infarct showing myocardial necrosis and a heavy polymorphonuclear infiltrate.


Resting electrocardiography showed typical atrial flutter with 2:1 or 3:1 conduction before the radiofrequency ablation.


Ablation of atrial flutter. (A) The fluoroscopic image, left anterior oblique, showing the position of ablation and diagnostic catheters.


Ablation of atrial flutter. (B) Intracardiac electrogram showing typical counterclockwise atrial flutter. ABL, ablation; HIS, His bundle; CS, coronary sinus; RVA, right ventricular apex.


Acute occlusion of right coronary artery. (A) Coronary angiography, right anterior oblique, showing total occlusion of at the distal portion of right coronary artery (arrow).


Acute occlusion of right coronary artery. (B) Revascularization after balloon angioplasty with resultant 20% residual stenosis.


Acute occlusion of right coronary artery. (C) The fluoroscopic image, left anterior oblique, showing the position of ablation catheter tip during radiofrequency ablation (arrow).


Echo image showing large left coronary artery aneurysm opening into right ventricular outflow tract.


Angiographic view of the root of aorta showing large left coronary artery aneurysm, faintly opacifying distal left anterior descending artery and prominent right coronary artery.


Retrograde filling of the left coronary system through coronary collaterals arising from the right coronary artery.


Extracranial CTA: Diffuse severe left ICA narrowing from 0.5 cm beyond the carotid bifurcation (arrows), consistent with "Alagille vasculopathy. ".


Formal Catheter Angiography: Sagittal views following left carotid injection showed >=75% extracranial LICA stenosis (arrow). LICA was occluded in the supraclinoid segment after the left ophthalmic artery origin with moyamoya phenomenon (not shown).


AP views following left vertebral artery injection showed moyamoya phenomenon around the proximal left PCA (arrow).


Cardiac MRT before initiation of treatment.


Cardiac MRT in peripheral euthyroid state.


Abdominal computed tomography (CT) scan and duodenography. . (a) Postoperative abdominal CT scan revealed that the I-shaped graft had good patency (white arrow).


Abdominal computed tomography (CT) scan and duodenography. (b) Contrast media passed through the duodenojejunostomy without any problem.


Upper gastrointestinal endoscopy (UGE) and abdominal computed tomography (CT) scan. . (a) UGE revealed the beating hematoma on the anal side of the major papilla.


Upper gastrointestinal endoscopy (UGE) and abdominal computed tomography (CT) scan. Axial.


Operative finding. . A 1-cm perforation was found in the third part of the duodenum (white arrow).


Abdominal computed tomography (CT) scan. . Postoperative abdominal CT scan showed that endovascular aneurysm repair was performed and the superior mesenteric artery was reconstructed (white arrow).


Computed tomography head showed an acute left subdural hemorrhage with significant left-to-right midline shift.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (a) Axial T2-weighted sequence.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (b) Axial T2-FLAIR sequence.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (c) Axial 3D TOF.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (d) Sagittal 3D TOF.


(A) Chest radiograph on the day of admission revealed pulmonary congestion bilateral, cardiothoracic ratio of 60%, and implanted pace maker.


(B) Computed tomography of the abdomen demonstrated high density throughout the liver and dilation of the hepatic veins and inferior vena cava.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (A) Displayed from left to right are the representative whole-cell inactivation recordings of WT Nav1.5 + beta1 and Nav1.5-F1571L + beta1. The INa were elicited with the pulse protocol shown underneath the traces.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (B) The time constants of channel inactivation for WT Nav1.5 (black circles, n = 5), WT Nav1.5 + beta1 (gray circles, n = 12), Nav1.5-F1571L (full red inverted triangles, n = 9), and Nav1.5-F1571L + beta1 (open red inverted triangles, n = 12). The values shown are means +- SEM.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (C) Voltage dependence of channel inactivation obtained by plotting the normalized current amplitudes at -10 mV, elicited after 500 ms of conditioning pre-pulse depolarization, as a function of the pre-pulse potential.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (D) Displayed from left to right are the representative whole-cell recordings of recovery from inactivation of WT Nav1.5 + beta1 and Nav1.5-F1571L + beta1. The protocol used is shown underneath the traces.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (E) Graph representing the recovery from inactivation, sampled after 500 ms from induction of inactivation.


3D CT reconstruction image of pelvis showing bilateral calcification of the vas deferens.


Occlusion of the left main.


After single ballon dilatation of the left main.


Right coronary artery.


showed normal sinus rhythm with prolonged QTc interval of 527 msec and some non-specific T wave changes over the inferior leads.


Coronary angiogram showing normal coronary artery.


Normal heart.


Tako-Tsubo sign. With apical ballooning (end-systolic view).


Resting ECG of the patient.


Original case TEE sequence in anaesthesia #4. A. Acute onset of left ventricular dysfunction/considerable hypokinesia (reduced contractility: outer circle: diastole; inner circle: systole).


Original case TEE sequence in anaesthesia #4. B. After successful therapeutic intervention: normal left ventricular function/no considerable wall motion abnormalities (normal contractility: outer circle: diastole; inner circle: systole).


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). A: Placement of catheters during ablation at the posterior aspect of right ventricular outflow tract (RVOT).


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). B: Placement of catheters during ablation at the right coronary cusp (RCC). Note the proximity of the RCC ablation site to the RVOT ablation site shown in panel A.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). C: Right coronary angiography before ablation at the RCC. The white star indicates the RCC ablation site from panel B, which was located anteriorly to the right coronary artery in right anterior oblique (RAO) view.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). D: Same images as panel C but with the ostium (white arrows) and the ostial portion (white lines) of the right coronary artery marked. Note that the ostium was located much higher than the distal tip of the ablation catheter (ABL) and the ostial portion ran inferiorly.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). E: Intracardiac electrogram recorded at the RVOT ablation site during VT. Local ventricular activation recorded at the distal (d) bipolar (Bi) electrode of the ABL showed an upright initial R wave preceding the onset of the QRS complex by 30 ms. Simultaneous recording of the unipolar (Uni) electrode of the ablation catheter displayed a QS pattern.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). F: Intracardiac electrogram recorded at the RCC ablation site during VT. Local ventricular activation showed not an initial positive but an early activation preceding the onset of the QRS complex by 27 ms (arrow) in the distal bipolar recording and exhibited a QS pattern in unipolar recording. See text for further discussion. EPI = epicardial mapping catheter inserted via subxiphoid puncture (catheter placed only for mapping, and catheter location not related with any endocardial ablation sites); HBE = His-bundle catheter; LAO = left anterior oblique; p = proximal; RVA = right ventricular apex catheter.


Right coronary artery stenosis. A: Twelve-lead ECGs just before (left) and after (right,asterisks) ST elevation in the inferior leads.


Right coronary artery stenosis. B: Right coronary angiography (left anterior oblique view) showing acute stenosis just after ST-segment elevation was first observed (top) and after balloon angioplasty (bottom). White arrows indicate stenotic lesion.


Right coronary artery stenosis. C: Intravascular ultrasound showing stenosis after repeated nitroglycerin injection (top) and after balloon angioplasty (bottom). White arrow indicates eccentric intimal thickening that successfully resolved after angioplasty. Neither coronary artery dissection nor thrombus was observed. See text for further discussion.


Non sustained ventricular tachycardia at exercise stress test (treadmill).


Cardiac magnetic resonance shows single coronary origin from left coronary sinus with malignant course of the right coronary artery (arrow).


Catheter coronary angiography detects anomalous origin of coronary arteries from left coronary sinus, with slit like right coronary ostium (arrow).


Catheter coronary angiography detects a bridging muscle in middle segment of the left anterior descending artery (arrow).


Axial.


Coronal images of the unenhanced computed tomography (CT) scan of the brain showed an acute left middle cerebral artery (MCA) infarction, which manifested as cortical and subcortical hypodensity with loss of gray-white matter differentiation and cortical swelling involving the left frontal, parietal, and temporal regions (asterisk); hyperdense MCA signs were also noted (arrow).


Axial maximum intensity projection (MIP) images of the CT angiogram of the brain showed complete occlusion of the left supraclinoid internal carotid artery and proximal MCA (arrows).


(E) Brain CT demonstrated the presence of a malignant MCA infarction with hemorrhagic transformation, causing significant midline shifting and mass effect.


(F) Postoperative CT.


Cardiovascular magnetic resonance imaging with inversion recovery sequence using long inversion time showed area of no contrast uptake at the basal anterior and anterolateral wall.


Blue arrows) that improved on the similar sequence repeated 30 minutes later. Arrows) consistent with microvascular obstruction.


Cardiovascular magnetic resonance imaging with inversion recovery sequence using long inversion time showed area of no contrast uptake at the basal anterior and anterolateral wall (E, F) Left atrial appendage thrombus (yellow arrow) was also discovered on this sequence. Image enlarged using letsenhance. Io.


(E, F) Left atrial appendage thrombus (yellow arrow) was also discovered on this sequence. Image enlarged using letsenhance. Io.


12-lead ECG (left, posterior and right leads) performed in our emergency room showing ST-segment elevation in the inferior leads (II, III, aVF) and V5, V6.


Final image with successful PCI of the LAD artery and good coronary flow.


Balloon sizing the atrial septum through a retrograde approach.


NSR with dynamic changes in T-waves in V1 and V2 when comparing two ECGs.


Repeat ECG after second emergency department visit.


Facial dysmorphism in velocardiofacial syndrome.


Magnetic resonance imaging (MRI). (A) Magnetic resonance angiography showing a drop in signal at the 12th thoracic level.


Magnetic resonance imaging (MRI). (B) MRI showing no ischemic or demyelinating lesion.


Macroscopic view of the right side of the heart, showing downward ventricular insertion of the tricuspid valve ring ("atrialization of the right ventricle"), leaflets partially adherent to the ventricular wall and free portion dysplastic. It also shows a right ventricle with minimal chamber and a "canal" outlet chamber to the pulmonary valve, due to the mal-positioned tricuspid leaflets (source: INMLCF, I. P. , with permission).


Macroscopic view of the Quadricuspid Pulmonary Valve, with three equal-sized cusps and an extra (No. 4) smaller one (source: INMLCF, I. P. , with permission).


Case A. Transthoracic echocardiogram demonstrates an elongated and thickened anterior mitral valve leaflet. The posterior leaflet was extremely hypoplastic with just a short visible stump. A noncompaction picture of the left ventricle lateral wall is visible.


Case A. Transthoracic echocardiogram shows a marked hypoplasia of the posterior mitral leaflet and a normal sized anterior leaflet.


Case A. Transthoracic echocardiogram-4C color Doppler demonstrating an eccentric severe regurgitation jet.


Case A. Two-dimensional transesophageal echocardiography demonstrating an anterior-posterior bicuspid aortic valve (opening phase).


Case A. Two-dimensional transesophageal echocardiography demonstrating an anterior-posterior bicuspid aortic valve (closure phase).


Case A. Three-dimensional real-time transesophageal echocardiography demonstrating the lack of posterior mitral leaflet.


Case B. Transthoracic echocardiogram shows a marked hypoplasia of the posterior mitral leaflet and a normal sized anterior leaflet.


Case B. Transthoracic echocardiogram- Parasternal Long Axis (PLax) demonstrating a severe hypoplasia of mitral posterior leaflet.


Electrocardiogram (ECG) results. The pre procedural electrocardiogram revealed an ST-segment elevation in the V2-6 leads.


Electrocardiogram (ECG) results. The post-procedural electrocardiogram showed an improvement in ST-segment elevation in the V3-6 leads.


This figure (Video 1) shows the steps of the procedure; 1. Inserting the filter device (Filtrap ) and unfolding it beyond the occlusion; 2. Advancing the guide extension catheter (GuideLiner ) and capturing the huge thrombus between the tip of the GuideLiner. catheter and the filter body of the Filtrap ; 3. Pulling them back together out of the guide catheter.


Thrombus retrieved from the left anterior descending artery.


Left coronary arteriogram of a young patient with antiphospholipid syndrome and myocardial infraction on admission showing thrombotic stenosis of left descending coronary artery at the level of the proximal section.


Arteriogram of a young patient with antiphospholipid syndrome and myocardial infraction after PTCA showing evidence of successful recanalization.


Four-chamber view echocardiography of a young patient with antiphospholipid syndrome and myocardial infraction showing an apical large thrombus measuring 38x18 mm.


Presenting chest radiograph showing cardiomediastinal silhouette enlargement with mild congestion and pleural opacity on the right chest wall. Annular calcific pericardial ring later seen on echocardiogram, coronary angiography, and computed tomography scan is not well visualized.


Presenting echocardiogram showing pericardial calcification. (a) Apical four chamber and parasternal short axis.


Presenting echocardiogram showing pericardial calcification. (b) Views showing pericardial thickening (shown by arrows).


Reconstructed computed tomography scan image showing the calcific ring.


The distal first diagonal artery stent (arrow) crossing underneath the calcific band.


Autopsy gross specimens of lungs and heart. (a) Lung gross specimen showing pulmonary thromboemboli with massive right pulmonary hemorrhagic infarct and pleural hemorrhage which was thought to be the cause of death.


Autopsy gross specimens of lungs and heart. (b) Dissected specimen of left anterior groove with patent and intact recently placed first diagonal artery stent (arrow).


Autopsy gross specimens of lungs and heart. (c) Gross specimen of heart with hypertrophied left ventricle and fibrocalcific constrictive annular band in atrioventricular groove (arrow) with dense fibrosis and calcification.


CECT scan of chest showing bilateral diffuse ground glass opacities.


At onset of cerebral infarction, diffusion weighted magnetic resonance imaging (DW-MRI) revealed fresh infarctions in the left cerebral hemisphere (1-A, arrows).


MRA revealed a stenotic lesion in the cervical segment of the left ICA (1-B, arrow).


DSA (1-. Arrow).


MRA (1-. Arrows) on the second day after the onset revealed no evidence of stenosis.


Chest X - Ray Posterior - Anterior and Lateral Views Showing Dilated Main Pulmonary Artery and the Catheter.


Echocardiogram Showing the Catheter Traversing the Interatrial Septum. Abbreviations: RA, Right Atrium; LA, Left Atrium.


Intraoperative Photograph of the Entrapped Catheter in the Interatrial Septum. Abbreviations: RA, Right Atrium; SVC, Superior Venacave; IVC, Inferior Venacave (Inset-extracted catheter tip).


Intraoperative Photograph of Domed, Stenosed Bicuspid Pulmonary Valve.


Risk factors for aHUS recurrence after uDCD. Modified from Zuber et al. . uDCD = uncontrolled donation after circulatory death; cDCD = controlled donation after circulatory death; IS = immunosuppressive; IRI = ischemia-reperfusion injury.


Erect abdominal radiograph demonstrating fullness of bilateral renal fossae with obscuration of the psoas outline suggestive of renal masses. Associated mass effect evidenced by inferior displacement of adjacent bowel loops.


Sagittal ultrasound image of the right kidney depicting a large perirenal hypoechoic fluid collection with hyperechoic internal echoes compatible with complex fluid. Associated medial displacement and compression of the right kidney. Similar findings were seen on the contralateral side (not shown).


(a, b) Contrast-enhanced axial and coronal computed tomography of the abdomen demonstrating large bilateral subcapsular collections (stars) causing compression of the renal parenchyma (arrowheads).


CT scan of the brain. (A) Left side: cortico-subcortical temporo-parieto-insular hypodensity. Right side: subcortical lenticular hypodensity.


CT scan of the brain. (B) Left side: cortico-subcortical parietal hypodensity.


CT scan of the brain. (C,D) Right side: cortico-subcortical parietal hypodensity.


CT scan showing the ARSA and related pseudoaneurysm and the dissection.


3D CT reconstruction.


CT scan showing correct positioning of the endovascular stent graft.


Summative timeline showcasing key findings of the patient's evolution and detailed treatment (case 1).


Summative timeline showcasing key findings of the patient's evolution and detailed treatment (case 2).


(a-c) Para-sternal short axis views showing the non-compacted layer with numerous trabeculations. Figure 1b illustrates the two separate layers.


Cardiac MRI: four chamber view with some degree of motion artifact. Red arrow represents the non-compacted myocardium.


Echocardiography image showing large pseudoaneurysm of the posterolateral wall.


Telemetry showed ventricular tacycardia with heart rate of 149 bpm.


Pre-operative right coronary artery
angiography.


Early post-operative electrocardiogram.


Electrocardiogram at the time of chest pain 3 days after the surgery.


Non-selective aortic root injection
angiography.


Selective right coronary artery angiography after infusion of intravenous trinitroglycerine.


Electrocardiogram after transient right coronary artery spasm.


A. The electrocardiogram showed ST-segment depression in leads V3-V6 and D1-aVL.


B. Coronary angiogram in the right caudal view shows the left coronary artery, circumflex artery and intermediate artery.


C. Coronary angiogram in the left anterior oblique cranial view shows the circumflex artery and right coronary artery originating from right sinus of Valsalva. (CX: circumflex artery, IM: Intermediate artery, LAD: left anterior descending artery, LSV: Left sinus of Valsalva, RCA: Right coronary artery, RSV: Right sinus of Valsalva).


The electrocardiogram showed no ST-segment depression or elevation.


A. Coronary angiogram in the left caudal view shows the left coronary artery tree with a circumflex artery.


B. Coronary angiogram in the left anterior oblique cranial view shows the circumflex artery and right coronary artery originating from right sinus of Valsalva.


C. The significant lesion, in the left anterior oblique cranial view, shows the circumflex originating from right sinus of Valsalva.


D. After stenting the significant lesion, in left anterior oblique view shows the circumflex artery originating from right sinus of Valsalva (CX: circumflex artery, LAD: left anterior descending artery, LSV: Left sinus of Valsalva, RCA: Right coronary artery, RSV: Right sinus of Valsalva).


A: H&E, 40x, Well circumscribed tumor with compressed peripheral adrenal parenchyma (black arrow). 2b: H&E, 100x, Nests of tumor cells with circumscribed margin and adjacent normal adrenal parenchyma (black arrow). 2c: H&E 100x Nests and trabecular pattern of tumor cells, separated by thin fibrovascular septae. 2d: H&E, 400x, Tumor cells having moderate amount of granular eosinophilic cytoplasm, centrally placed round nucleus with fine granular chromatin and inconspicuous nucleoli. Scattered sustentacular cells (black arrow) are also noted.


(A) Magnetic resonance imaging shows 1.6 cm-sized mass in anterior wall of the cervix (white arrow indicates the cervical mass).


(B) Gross finding shows the tumor confirmed as poorly differentiated squamous cell carcinoma with clear resection margin (measuring 3.3 x 3.0 x 0.5 cm) (white arrow indicates the cervical mass).


The needle attached to semen containing syringe was put into the posterior cul-de-sac along the biopsy guide.


A; Right anterior oblique (RAO) lateral view. Manipulation of Gaia second guidewire with Crusade catheter during dilation for the right ventricular (RV) branch true lumen by 1.5 mm balloon.


B; While the tip of Gaia second guidewire was facing on the balloon through the strut, immediately balloon deflation was applied. The Gaia second guidewire could pass to the RV branch true lumen in the same space of the first protection guidewire.


C; Kissing balloon inflation at the right coronary artery main vessel and RV branch with 4.0 mm and 2.0 mm balloon, respectively.


D; Final angiogram. The RV branch was restored; the main coronary vessel also showed optimal result.


Transthoracic echocardiography on admission and four days later after percutaneous coronary intervention (PCI). Echocardiography on admission showing global hypokinesia, mild mitral regurgitation (MR) and left atrium (LA) enlargement (LA volume, 54 mL) (A, B).


Transthoracic echocardiography on admission and four days later after percutaneous coronary intervention (PCI). Four days later after PCI, left ventricular contraction and LA enlargement have improved (LA volume, 34 mL), and MR has resolved (C, D).


Coronary artery angiography during the primary percutaneous coronary intervention. (A) Left coronary angiography showing significant stenosis from the distal left main coronary artery to the mid left anterior descending artery with thrombolysis in myocardial infarction (TIMI) 2 flow and total occlusion at the ostium of the left circumflex artery with TIMI 0 flow.


Coronary artery angiography during the primary percutaneous coronary intervention. (B) Final coronary angiography showing successful revascularization without periprocedural complications.


Computed tomography scan revealing consolidation and ground-glass opacity in the dependent portion of the right lung, with pleural effusion limited to the right lung.


(A-C) depict the axial, coronal, and sagittal panel of the preoperative CTA, respectively. The white arrows indicated the fistula and RCAA.


(D-F) depict the axial, coronal, and sagittal panel of the 6-months follow-up CTA, respectively. The white arrows indicate the mild dilated RCA.


(G,H) show the preoperative and postoperative echocardiography images of the patient. A large fistula and RCCA to RV shunt was indicated by the arrow. RCA, right coronary artery; RCAA, right coronary artery aneurysm; LV, left ventricle; RV, right ventricle.


(A,B) depicted the reconstructed image of the heart and dilated right coronary artery.


(C-F) depicted the surgical repair process. RCA, right coronary artery; RCAA, right coronary artery aneurysm; AO, aorta.


The 5-chamber view of the heart at 25.3 weeks showing the fistula between the left coronary artery and coronary sinus (arrow, A).


Power Doppler imaging confirming the communication between the left coronary artery and coronary sinus (B).


The 4-chamber view of the heart at 29.6 weeks showing the dilated coronary sinus (arrow) with the collapsed left atrium (C). . Ao, aorta; CS, coronary sinus; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.


Postnatal computed tomography showing the dilated left circumflex artery draining into the enlarged coronary sinus on the axial image (arrow.


The 3-dimensional volume rendering image (arrow,. . Ao, aorta; CS, coronary sinus; LAA, left atrial appendage; LCX, left circumflex coronary artery; LMA, left main coronary artery; PA, pulmonary artery.


Clinical fundus photo of a 44-year-old male presenting with diminution of vision following dengue fever. (A) Right eye. (A) Right eye showing additional retinal whitening exclusively inferior to the right macula.


Clinical fundus photo of a 44-year-old male presenting with diminution of vision following dengue fever. (B) Left eye. Both eyes depicting perivascular exudates, intraretinal hemorrhages, cotton wool spots and macular edema.


Fundus fluorescein angiography of a 44-year-old male presenting with diminution of vision following dengue fever. (A) Right eye.


Fundus fluorescein angiography of a 44-year-old male presenting with diminution of vision following dengue fever. (B) Left eye. Both eye showing disc and perivascular leakage limited to posterior pole indicative of vasculitis. In addition, there is capillary nonperfusion due to occlusion of multiple small arterioles supplying the macula of right eye confirming macular ischemia.


Electrocardiogram of the patient before admission.


At discharge.


Real-time monitoring of the patient's vital signs during hospitalization.


Level of cholinesterase.


Cardiac troponin I. Before admission and at discharge.


(A) Pedigree analysis of the family of patient 1. The arrow points out the proband. Circles correspond to female. Squares correspond to male. The mutation was indicated -/- if negative and ?/? if untested.


(B) Genetic testing of patient 1 showed a guanine deletion at position 973 (c.973delG) in exon 8 of the LAMP2 gene.


The echocardiogram of patient 1: substantial left ventricular hypertrophy with a maximal thickness in the posterior wall of the left ventricle of 10 mm and a ventricular septal thickness of 15 mm, and obstruction in the left ventricular outflow tract.


Right coronary artery-right ventricle (RV) fistula. A
Arrow showed the dilated right coronary artery. B
Arrow showed the aneurismal dilatation of right coronary artery. C
Arrow showed fistula ostium. D; The spectrum of fistula was continuous. Ao aorta, LA left atrium, LV left ventricle, RA right atrium, RV right ventricle.


Left anterior descending-pulmonary artery fistula. A
Arrow showed the abnormal blood flow in the pulmonary artery. B
Arrow showed the origin of the fistula is left anterior descending. C; The spectrum of fistula showed only in diastole.


Left circumflex (LCX)-coronary sinus (CS) fistula. A LCX was dilated and connected with CS. B; CS was connected with right atrium (RA). CS coronary sinus, LCX left circumflex, LV left ventricle, RA right atrium, RV right ventricle.


EKG with ST elevations in anterior leads.


Echocardiogram with severe hypokinesis of anterior, anteroseptal walls, and apex.


Chest X-ray showing dilated cardiomyopathy.


Tilt test registration. The figure shows the recording of systolic blood pressure, diastolic blood pressure, and heart rate in clinostatic and sitting position (passive orthostatic position not performable because of severe presyncopal symptoms) during a tilt test. In sitting position, an immediate reduction in systolic blood pressure to 55 mmHg and diastolic blood pressure to 28 mmHg is evident, without any change in the heart rate, which remains stable at 76 beats/min.


Electrocardiogram ,cardiac ultrasound.


The figure shows the 12-lead electrocardiogram pointing out the first-degree atrioventricular blockage (panel A). In panel B, cardiac ultrasound (parasternal long-axis view) depicts left ventricle wall thickness, diffuse myocardial hyperechogenicity, and mild pericardial effusion.


Four-chamber view in a transthoracic echocardiogram showing enlargement of
the left ventricle (LV) (The LV apical structure was unclear in this view).


Cine cardiac magnetic resonance imaging (MRI) image in a four-chamber view
shows bulging of the interventricular septum (IVS) toward the right ventricle (white
arrow) and invagination of fatty material (black arrow).


A T1-weighted image shows bright tissue replaced in the left ventricle (LV)
apical position (white arrow), which could suggest the presence of fat replacement.


A late gadolinium enhancement (LGE) image performed 10 minutes after the
contrast media injection showed no intramyocardial hyperenhancement area but indicated
the presence of myocardial tissue in the out pouching; this confirmed the congenital
nature of the diverticulum.


Medical image.


Admission head computed tomography demonstrates a metallic foreign body projecting in the region of the right transverse sinus (arrow). The bullet previously seen in the right transverse sinus is no longer evident on the follow-up head computed tomography angiography.


Chest radiograph obtained at admission (a) demonstrates no cardiopulmonary abnormality.


A follow-up chest radiograph (b) shows a 5 mm round metallic foreign body projecting over the left hilum (open arrow) with interval development of a wedge shaped pulmonary opacity a the left lung base (arrow head).


Case 1: left CAG showed a huge aneurysm with calcification of the proximal left coronary artery, and the LAD is obstructed at the outflow of the aneurysm (red arrowhead), and the blood is supplied by the collateral circulation tract from the right coronary artery. LAD, left anterior descending artery; LCX, left circumflex artery.


Case 1: macrofindings of the LAD aneurysm during surgery. A giant coronary aneurysm prior to resection is observed. A hard and calcified mass >40 mm in diameter is present. The mass was filled with a red blood clot. LAD, left anterior descending artery.


Case 2: right CAG at 1 year after CABG. The blood flow supply from the GEA to the distal site of RCA was adequate. CAG, coronary artery angiogram; CABG, coronary artery bypass graft surgery; GEA, gastroepiploic artery; RCA, right coronary artery.


Coronary angiogram in the right anterior oblique cranial view (A), showing the left circumflex artery (LCx) (arrow) and the left anterior descending artery (LAD) originating from the left main coronary artery.


When the right coronary ostium was cannulated (B), another circumflex artery (RCx) (arrow) was noticed in addition to a right coronary artery (RCA) in the left anterior oblique cranial view.


Preoperative left internal carotid angiograms showing anomalous arteries arising from the internal carotid arteries, which and run anteromedially along the frontal base and making a hairpin-pin bend, and a saccular aneurysm is seen on the hairpin-pin bend, lateral view.


Oblique view.


Preoperative angiograms revealing an aneurysm with oblique view. Postoperative angiograms showing no filling of the aneurysm.


(A) Plasma glucose trend in case 1.


(B) Plasma glucose trend in case 2.


MRCP image shows intra and extrahepatic biliary dilation secondary to tumor lesion of the head of the pancreas.


Fluoroscopic image observing LAMS between duodenal bulb and bile duct.


Endoscopic ultrasound vision shows the distal flange of LAMS (HOT AXIOS) in to the CBD.


CT scan coronal view shows LAMS in proper position.


Duplex ultrasound demonstrating retrograde flow through the right external carotid artery that supplies antegrade flow to the right internal carotid artery.


Intraoperative photo of the opened common carotid artery revealing a hard calcific plaque with soft thrombus.


Excised ruptured hydatid cyst wall.


(A) MDCT image of the LAD in an enhancement scan.


(B) MDCT image of the LAD in a plain scan. LAD, left anterior descending coronary artery; MDCT, multidetector computed tomography.


Visualization of the coronary angiography. (A) Intraoperative open-heart coronary angiography shows no significant stenosis in the left coronary artery.


Visualization of the coronary angiography. (B) Intraoperative open-heart coronary angiography shows no significant stenosis in the right coronary artery. LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery.


Treatment course of maggot therapy. (a) Before maggot therapy. Necrotic tissue is seen on the surface of the wound.


Treatment course of maggot therapy. (b) After one session (48 h) of treatment, the reduction of necrotic tissues is seen.


Treatment course of maggot therapy. (c) Maggots growing from second to third instar larvae.


Treatment course of maggot therapy. (d) After six sessions of treatment, debridement was conducted to the deep portion from the ulcerated base, and favourable granulation can be seen on the amputated surface.


Intra-/post-operative view. (a) Intra-operative. Additional debridement is done.


Intra-/post-operative view. (b) Three post-operative weeks. Approximately 70% of the skin graft was taken. After conducting partial simple reefing, split thickness skin graft of 20/1000 inches was used.


Short LAD arises from the left sinus of Valsalva and gives rise to one septal branch, little intermedius branch, and one diagonal branch.


Circumflex artery (LCX) is aplastic, as shown in the left caudal angiographic projection.


Right coronary artery (RCA) is normal in its origin and course.


Long LAD arises from the right sinus of Valsalva with a separate ostium, different from RCA. This LAD is longer than the first, runs on the right ventricle, and gives rise to septal and diagonal branches, supplying the mid and distal territories of septal, anterior, lateral wall, and apex.


Overlapping Figures 1 and 5, we can see the entire course of LAD along interventricular sulcus to the apex.


A 55-year-old male with confirmed IgG4 vasculopathy. Axial maximum intensity projection (MIP) image of CT coronary angiography shows partially thrombosed aneurysm of the left anterior descending artery (arrows).


A 55-year-old male with confirmed IgG4 vasculopathy. Volume rendered image shows the aneurysm of the left anterior descending artery (in pink).


A 55-year-old male with confirmed IgG4 vasculopathy. The right anterior oblique caudal view of conventional angiography shows aneurysmal dilatation of the left anterior descending artery with contrast blush (*).


A 55-year-old male with confirmed IgG4 vasculopathy. Coronal maximum intensity projection images of CT abdominal angiography in arterial.


A 55-year-old male with confirmed IgG4 vasculopathy. Venous. Phases show partially thrombosed aneurysm in the proximal part of 8th right intercostal artery (*). Enhancing nodular paravertebral soft-tissue thickening is noted adjacent to the proximal right intercostal arteries above and below this level.


A 55-year-old male with confirmed IgG4 vasculopathy. Axial image of CT abdominal angiography in the arterial phase shows a partially thrombosed aneurysm in relation to the common hepatic artery. Artifacts are seen in relation to the aneurysm (post-injection in the gastroduodenal artery). The aortic stent graft is also seen in situ.


A 55-year-old male with confirmed IgG4 vasculopathy. Coronal maximum intensity projection image of CT abdominal angiography shows multiple visceral artery aneurysms - in relation to the common hepatic artery (black arrow), inferior pancreaticoduodenal artery (white curved arrow), and the jejunal branch of superior mesenteric artery (white arrow). Artifacts are noted in relation to the gastroduodenal artery, aorta, and the superior mesenteric artery - representing stent grafts and post-procedural changes. Cholecystectomy clips are also seen.


Clinical course and IgG index. MMT, manual muscle testing; CSF, cerebrospinal fluid; IVMP, intravenous methylprednisolone pulse therapy; M, magnetic resonance imaging; N, Nerve conduction study.


Initial electrocardiography revealing ST segment elevation in leads V1-V3.


Transesophageal echocardiography image revealing spongy appearance of the right ventricle with trabeculations forming deep fissures and grooves, located in the right ventricle apical wall.


Transesophageal echocardiography contrast echo demonstrating flow from right ventricular cavity into the trabecular recesses.


Fluorescein angiography showed profound macular and peripheral ischemia in the early phase.


In the middle phase.


In the late phase. Composite view).


Follow-up fluorescein angiography showed profound macular and peripheral ischemia in the early phase.


Four-chamber transthoracic echocardiography.


Cardiac magnetic resonance (CMR) images. Reveal concentric hypertrophy with moderately impaired left ventricular function and multiple cystic structures in the septal, mediolateral and anterior parts of the left ventricle.


Medical image.


Late gadolinium enhancement (LGE) demonstrated high signal intensity of the cystic lesions indicating fibrotic tissue , Short axes of the corresponding sequences: transthoracic echocardiography.


Late gadolinium enhancement (LGE) demonstrated high signal intensity of the cystic lesions indicating fibrotic tissue , Cine-CMR.


Late gadolinium enhancement (LGE) demonstrated high signal intensity of the cystic lesions indicating fibrotic tissue. And LGE.


Cardiovascular magnetic resonance mapping of T1 ,. T1 Mapping (1425 +- 144).


T2 . T2 Mapping (60.5 +- 8.2).


Extracellular volume. At 32 months post-transplant FU revealed increased values. Extracellular volume (32.7 +- 9.6).


Timeline of postoperative course after heart transplantation. ATG, Antithymocyte globulin; CMR, Cardiac magnetic resonance tomography; HLA-AB, Human leukocyte antigen antibodies; ICU, Intensive care unit; IgG, Immunoglobulin G; IMC, Intermediate care unit; LV, Left Ventricle; LVEF, Left ventricular ejection fraction; LVAD, Left ventricular assist device; MELAS, Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes; MMF, Mycophenolate Mofetil; nsVT, Non sustained ventricular tachycardia: pAMR, Pathologic Antibody mediated rejection; RV, Right ventricle; RVEF, Right ventricular ejection fraction; TDI-Sm, Tissue Doppler Imaging Systolic peak velocities (radial/longitudinal); TTE, Transthoracic echocardiography.


Electrocardiogram and Chest X-ray. (A) ECG showed sinus rhythm, 60 bpm, normal axis, fragmented QRS in the inferior leads (III, aVF) and flat T waves in III, aVF and V6. When compared to previous ECGs, no new abnormalities were observed.


Electrocardiogram and Chest X-ray. (B) Chest X-ray with a single lead ICD, normal heart size and no signs of pulmonary congestion.


Echocardiography. Parasternal long axis view showed mild left ventricular enlargement, both left ventricular end-diastolic.


Echocardiography. End-systolic. Diameters. Right ventricle, ascending aorta and left atrium were of normal size. Interventricular septum and posterior left ventricular wall had normal thickness. No pericardial effusion was observed.


Dynamic of high sensitivity cardiac troponin I levels. Hs-cTnI levels peaked at admission. Three days later, with ongoing recurrent episodes of chest pain, a further increase in hs-cTnI value was observed. After starting aspirin and colchicine, chest pain resolved and hs-cTnI levels progressively decreased. At discharge, hs-cTnI value was almost normal (normal range 0-58.05 ng/l).


Electrocardiogram at admission. Atrial fibrillation, mild ST segment depression in leads V 3-6. T wave inversion.


Diagnosis and treatment of the patient.


Electrocardiogram after resuscitation. Still atrial fibrillation, ST segment depression was significantly deepened and ST segment elevation in aVR lead.


Coronary angiography. Sub occlusive thrombus in the proximal, medial and distal part of the right coronary artery (TIMI 2).


Coronary angiography. Normal flow through the right coronary artery.


RAO caudal view shows a mild lesion in the middle of the LCX artery.


LAO view demonstrates no RCA in the right sinus of Valsalva.


(C) Reconstructed three-dimensional image obtained by the volume-rendering technique shows the anomalous RCA with an interarterial course.


(D) Similarly, the anomalous RCA between the aorta and pulmonary trunk can be seen. . Abbreviations: LAO, left anterior oblique; LCX, left circumflex coronary artery; RAO, right anterior oblique; RCA, right coronary artery.


(A) Reconstructed three-dimensional image obtained using the volume-rendering technique shows the anomalous RCA with an interarterial course.


(B) The origin of the anomalous RCA is evident. . Abbreviation: RCA, right coronary artery.


(A) LAO cranial view shows an anomalous RCA arising from the left sinus of Valsalva.


(B) LAO cranial view shows a high-grade 90% stenosis in the proximal RCA.


(C) LAO cranial view shows a final good angiographic result after PCI procedure.


(D) Reconstructed three-dimensional image obtained by the volume-rendering technique shows the anomalous RCA with an interarterial course.


(E) The anomalous RCA originates from the left sinus of Valsalva. . Abbreviations: LAO, left anterior oblique; PCI, percutaneous coronary intervention; RCA, right coronary artery.


Coronary angiography: Total occlusion of right coronary artery (RCA) and left circumflex artery. Left anterior descending artery originating from RCA.


Computed tomography coronary angiography: Common ostium for right coronary artery (RCA) and left anterior descending artery; absent left main artery. Left circumflex artery short in length and significantly narrow in caliber; completely blocked RCA in proximal segment due to dense calcification.


Angiographic image of this patient. (A) (AP + CRA30 ) the left anterior descending branch.


Angiographic image of this patient. (B) (RAO30. + CAU20 ) the circumflex branch.


Angiographic image of this patient. (C) (AP + CRA20 ) the right coronary artery.


CT angiography volume rendered reformation image. The right coronary artery (RCA) is enormously dilated and tortuous with a large number of collateral vessels. Normal course of a very large right coronary artery is seen.


CT angiography multiplanar reformatted image. The dilated right coronary artery is emerging from the right aortic sinus.


CT angiography volume rendered image. Right coronary artery is dilated and tortious with a large number of collaterals feeding the left coronary system. Left coronary artery is emerging from pulmonary artery trunk. The left anterior descending artery and their diagonal branches are also dilated and tortuous.


Magnetic resonance imaging of the chest. . Notes: Increased signal is seen on T2-weighted images in subcutaneous fat in the anterior abdominal wall at the midline. Increased signal is also noted in anterior mediastinum fat posterior to the sternum. There is periosteum enhancement of the sternum manubrium and at the upper part of the body of the sternum after contrast administration. There is also increased signal in the bone marrow noted on T2-weighted images in the sternum manubrium and in the upper part of the body of the sternum, suggesting bone marrow edema. No evidence of fracture is noted. Findings are consistent with osteomyelitis involving the manubrium and the upper part of the sternum body. Arrows indicate the area of osteomyelitis.


Twelve-lead electrocardiogram showing complete left bundle branch block.


Four-chamber echocardiogram showing a dilated left ventricle.


The constantly deficient secretion of cortisol.


Contrast-enhanced computed tomography revealing atrophic bilateral adrenal glands (red arrows).


MRI showing the posterobasal left ventricular aneurysm (arrows).


A picture of PET scan showing viability of myocardium.


Aneurysm showing thrombus (arrows).


Mitral valve excised and replaced with #29 C. E. Bioprosthesis via left ventricle (arrows).


Completed linear closure of ventriculotomy buttressed with Teflon strips (arrows).


Non-contrast enhanced.


Contrast-enhanced. Black-blood thrombus images of the head in Case 1. The red arrow indicates the focal stenosis of the internal jugular vein and cerebral vein sinus.


(A-D) Magnetic resonance arthrography images of the head in Case 2. The red arrow indicates partial filling defects.


Magnetic resonance venography images of the head.


Neck. In Case 2.


Flow diagram of the study selection process on cyclosporine-A (CsA)-induced thrombosis.


The 3-dimensional (3D) volume rendered image demonstrates both of the left anterior descending arteries (LAD), one originating from the left main coronary artery and the second anomalous one from the right side and spreading to the anterior wall of the left ventricle toward the left ventricular apex.


The segmented 3D image demonstrates both the left anterior descending arteries (LAD), their origin and course.


Coronary angiogram images of the second primary angioplasty:
A and
B show the intrastent thrombus with mycotic aneurysm of the right coronary artery. C and
D show the right coronary artery angioplasty with an overlapping bare metal stent.


Parasternal short-axis view showing the classical windsock appearance of the ruptured sinus of Valsalva arising from the noncoronary sinus.


Communicating with the right atrium.


Electrocardiography on presentation shows a sinus rhythm of 65 beats/minute and ST elevation in V3, II and III.


The CAG. Shows the compression of the LAD coronary artery during the systole resulting in narrowing.


Performed after the second chest pain attack demonstrating a dissection in the distal left anterior descending coronary artery.


Parasternal short axis view at the level of the papillary muscles during the acute phase, demonstrating a small posterior pericardial effusion. The left ventricular contractile function is normal.


Parasternal short axis view at follow-up, demonstrating normal left ventricular contractility and resolution of pericardial effusion.


Parasternal short axis view at the aortic annulus demonstrating giant aneurysms in the right coronary artery, left anterior descending artery, and another giant aneurysm posteriorly in the left circumflex artery region.


Apical four chamber view with anterior angulation demonstrating all three giant aneurysms. The right coronary aneurysm lies at the atrioventricular groove (AV) and the left sided aneurysms are noted along the interventricular septum and the left AV groove.


Still frame image showing the diameter of the right coronary artery aneurysm.


Still frame image showing size of the coronary artery aneurysms of the left anterior descending artery and circumflex artery.


Aneurysm in the region of the circumflex branch of left coronary artery with an area of increased echogenecity along the aneurysmal wall, suspicious of a thrombus.


Selective left coronary artery angiogram in slight left anterior oblique view with caudal angulation. The left main coronary artery appears normal and trifurcates into the left anterior descending (LAD), ramus and circumflex branches. The giant aneurysm in the LAD appears globular in this view and is densely opacified. The ramus aneurysm is long and saccular, located inferior to LAD. There is ectasia of the circumflex branch.


AP view of the same demonstrating overlapping of ramus and LAD aneurysms.


Straight lateral view of a selective right coronary artery angiogram demonstrating a giant aneurysm just distal to the coronary ostium. Multiple small aneurysms are noted throughout the course of the right coronary artery and posterior descending.


showed QS patter with T-wave inversion in III and a VF.


CT angiogram showing bilateral pulmonary emboli.


CT scan Head without Contrast.


MRI Brain without contrast.


MRA Brain.


Troponin trend.


Echocardiographic features of myocardial crypts. Transthoracic
echocardiogram two-chamber view showing diastolic features of a myocardial crypt:
penetration perpendicular to myocardial wall, and ,contention by thin sub epicardial layer
(white arrow).


Echocardiographic features of myocardial crypts. Systolic sub-total obliteration on transthoracic
echocardiogram two-chamber view.


Echocardiographic features of myocardial crypts. Modified two-chamber view
demonstrates the presence of second, more apical crypt parallel of the previous one
(white arrow).


Optimal delineation of the two crypts in cardiac magnetic
resonance two-chamber view sequence (black arrows).


Obvious
hyperenhancement in the inferior wall (white arrows) with adjacent myocardial crypt
(open arrow) on the cardiac magnetic resonance-late gadolinium enhancement short-axis
sequence.


ECG upon arrival (March 2018).


ECG upon review 4 months later (July 2018).


Serial electrocardiograms, lead II strips. (a): normal, 5 months prior to admission.


Serial electrocardiograms, lead II strips. (b): Complete third-degree atrioventricular (AV) block, at primary office 12 h before admission.


Serial electrocardiograms, lead II strips. (c): Type I second-degree AV block, 2 h after admission and antibiotic therapy.


Serial electrocardiograms, lead II strips. (d): first-degree AV block, 12 h after admission and antibiotic therapy.


Serial electrocardiograms, lead II strips. (e): normal, at discharge.


The electrocardiogram recorded in emergency room (ER).


The electrocardiogram prior to antiarrhythmic treatment. The electrocardiogram shows a short PR interval, a delta wave, wide QRS complex, and ST depression.


Electrocardiograms with the sacral neuromodulation device in both on and off modes. (A) An electrocardiogram performed with the sacral neuromodulation implant in "off" mode shows no changes and a sinus rhythm in a patient on antiarrhythmic medication.


Electrocardiograms with the sacral neuromodulation device in both on and off modes. (B) An electrocardiogram performed with the sacral neuromodulation implant in "on" mode shows no changes and a sinus rhythm in a patient on antiarrhythmic medication.


ECG on admission demonstrating anterior ST-segment elevation.


Diagnostic coronary angiography of left coronary artery system . Views:. PA cranial.


Diagnostic coronary angiography of left coronary artery system . PA caudal.


Diagnostic coronary angiography of left coronary artery system . LAO Caudal.


RCA. LAO.


RCA. RAO.


Views of the RCA before.


After. Drug eluting balloon treatment. Markers indicate the RV branch which was occluded and subsequently recanalized following intervention.


Schematic drawing of the anomalous arteries and steno-occlusive changes found in this patient, showing the blood flow in the right internal carotid artery angiography.


The left vertebral artery angiography. As seen on Figures 2 and 3.


Echocardiogram in apical four chamber view. Left: Severe RV and RA dilatation. Right: Mild RV and RA dilatation in recovery.


Straight left upper border of heart.


Left ventricular (LV) apical aneurysm.


Echocardiography showing coronary sinus type of interatrial communication measuring 10 mm x 16 mm with left to right shunting.


Intraoperative finding of a pure coronary sinus type of interatrial communication measuring 1.5 cm in size and a normal coronary sinus ostium.


Resting ECG reveals delayed R wave progression.


Exercise ECG reveals significant ST elevation in lead V3.


Stanford type A DeBakey type II aortic dissection showing enlarged ascending aorta with an approximate diameter of 4.5 cm and dark reddish in color along its length. Extent of the aortic dissection reaches nearly 7 cm high.


(A) Section of the dissected ascending aorta showing the intramural hematoma that was found behind the brachiocephalic trunk.


(B) Section of the dissected ascending aorta revealing calcified left coronary cusp of the aortic valve and dissection entry, measuring around 5 mm, which was situated at the intima of the anterior wall of the ascending aorta, near the sinotubular junction.


(A) Supracoronary aortic tube graft 28 mm, 7 cm in length, placed directly at the sinotubular junction.


(B) Saphenous vein graft taken from the left lower extremity placed between the grafted ascending aorta and the LCX.


Admission electrocardiogram showing sinus rhythm and complete right bundle branch block.


Admission chest X-ray showing evidence of previous sternotomy (repaired tetralogy of Fallot), cardiomegaly and implanted cardioverter defibrillator in left pectoral region.


Right anterior oblique coronary angiography view of the patient. The arrows point to the stenotic sites, including the distal stenosis of the left main coronary artery, severe ostial stenosis of the left anterior descending artery, ramus intermedius artery, and left circumflex artery.


Left anterior oblique coronary angiography view of the patient, showing multiple stenosis at mid and distal parts of the right coronary artery (arrows).


(a) Left ventriculography (right anterior oblique view) showing a left ventricular cleft (white arrow) at the basal inferior wall in diastole.


(b) Transthoracic echocardiogram (apical 2-chamber view). Left ventricular cleft (white arrow) in the basal inferior wall in diastole.


(c) Transthoracic echocardiogram (apical 2-chamber view). More prominent demonstration of left ventricular cleft (white arrow) with contrast echocardiography in diastole.


(d) Cardiac magnetic resonance imaging (left ventricular long-axis view). Myocardial cleft (white arrow) in the basal inferior segment.


Left ventricular cleft narrowed in systole in (a) left ventriculography (right anterior oblique view).


(b) Transthoracic echocardiogram (apical 2-chamber view) with contrast.


(c) Cardiac magnetic resonance imaging (left ventricular long-axis view).


Two-dimensional echo apical four-chamber view.


X-ray image postimplantable cardioverter defibrillator placement.


Prominent 'q' wave, ST segment elevation and 'T' wave inversion in lead II, III and aVF with ST segment depression seen in lead I and aVL. Right sided chest leads (V4R-V6R) showed <1 mm ST segment elevation.


Chest radiograph showing cardiomegaly and pulmonary congestion upon admission.


Chest radiograph showing resolution of cardiomegaly with marked improvement of pulmonary congestion by day nine of hospitalization.


Free thyroxine (FT4) serum concentrations during hospitalization before and after therapeutic plasma exchange (TPE).


An 12-lead electrocardiogram showing acute ST-segment changes in leads II, III, and VF (shaded in light blue).


Follow-up cardiac catheterization demonstrates complete resolution of the right coronary artery dissection (areas corresponding to acute abnormalities noted on the initial cardiac catheterization - see Figure 2 - are circled).


Electrocardiographic examination shows left ventricular hypertrophy and T wave inversion.


Echocardiographic examination shows that the left ventricle cavity is smaller than normal and there is a significant hypertrophy in the septum.


Telecardiography shows epicardial ICD implantation.


Multiple metastasis. Although the ovary carcinoma was resected, liver, and bone metastasis (arrow) was detected. Multiple lymph nodes are swelling (arrowhead), indicating metastasis.


Sagittal computed tomography image of the brain demonstrates a posterior fossa anomaly with vermian hypoplasia, expansile arachnoid cyst, and hydrocephalus.


(a) Maximum intensity projections of computed tomography (CT) angiography demonstrate stenosis of the basilar artery and aplasia of the right common carotid artery.


(b) Multiplanar reconstruction of CT angiography of the neck demonstrates aplasia of the right internal carotid artery.


(c) Skull base CT scanning demonstrates an absence of the right carotid canal.


(d) Abnormal origin and course of the left subclavian vessels are demonstrated. Bilateral common carotid arteries have arisen from the distal side of the left subclavian artery.


(a) Single-photon emission computed tomography demonstrates reduced cerebral blood flow in the border zones between the middle and posterior cerebral artery territories in the right hemisphere.


(b) After extracranial-intracranial bypass, cerebral blood flow of the right hemisphere improves to the normal level.


The dysmorphic facies with hypertelorism and low-set ears.


Cerebral angiography of the left internal carotid artery (ICA) demonstrating severe stenosis of the left ICA at the distal cavernous-infraclinoid portion. The ocular artery was not confirmed (a).


Cerebral angiography of the left internal carotid artery (ICA) demonstrating severe stenosis of the left ICA at the distal cavernous-infraclinoid portion. Cerebral angiography of the left common carotid artery before stent placement demonstrating the ocular artery (arrows) was depicted by a collateral blood flow from the external carotid system (b).


Cerebral angiography of the left internal carotid artery (ICA) demonstrating severe stenosis of the left ICA at the distal cavernous-infraclinoid portion. Cerebral angiography of the left ICA after stent placement demonstrating the ocular artery (arrowhead) was depicted by a directed blood flow from the ICA (c).


Preoperative.


Postoperative. Fluorescent fundus angiography demonstrating the visualization of the retinal artery which improved markedly after the treatment.


A; Preoperative transesophageal echocardiography. Severe calcification was observed in all leaflets and aortic annulus (arrowheads).


B; Preoperative transesophageal echocardiography. The left coronary ostium was intact; there was no significant stenosis (dotted circle).


Preoperative coronary angiography. Left coronary ostium did not show significant stenosis (dotted circle).


Anesthetic record. start/end of surgery. PAP pulmonary artery pressure, CVP central venous pressure, AP arterial pressure, (1) start of CPB, (2) AVR, (3) withdrawal of CPB, (4) signs of left heart failure and appearance of left ventricular wall motion abnormality, (5) second run of CPB, (6) second withdrawal of CPB.


Electrocardiogram on admission and after stent implantation. . Notes:. Showing ST segment slope-down depression, and ,T-wave inversion in leads II, III, aVF, and ,V4-V6. T-wave amplitudes in leads II, III, aVF were decreased, compared with (A). . Abbreviation: ECG, electrocardiogram.


Electrocardiogram on admission and after stent implantation. ECG after stent implantation.


Colon under colonoscopy. . Notes: (A, B) Colonoscopy showing tumor with dirty white-yellow furs in the transverse colon.


Colon under colonoscopy. (C, D) Repeat colonoscopy showing normal colon 10 months after the operation.


ECG during stent thrombosis. . Notes: (A) ECG before recurrent chest pain.


ECG during stent thrombosis. (B) Inverted T-waves in leads II, III, and aVF. Increased T-wave amplitudes in leads III, aVF, and V1-V6, compared with.


ECG during stent thrombosis. ECG after PTCA, decreased T-wave amplitudes in leads II, III, and aVF, compared with . Abbreviations: ECG, electrocardiogram; PTCA, percutaneous transluminal coronary angioplasty.


ECG during stent thrombosis.


ECG changes of acute inferior wall myocardial infarction post-operation. . Notes:. Obvious elevation of ST segment in leads II and III, aVF compared with . Abbreviation: ECG, electrocardiogram.


ECG changes of acute inferior wall myocardial infarction post-operation. ECG 1 day before surgery.


Left anterior oblique caudal view in the coronary angiogram, showing a giant left coronary aneurysm.


Left anterior oblique cranial view in the coronary angiogram, showing a giant left coronary aneurysm (arrow).


Three-dimensional volume-rendering computed tomography, showing a giant aneurysm of the left main coronary artery.


Another view of the giant aneurysm with three-dimensional volume-rendering computed tomography.


CT chest on admission showed SVC thrombus that extended to involve the brachiocephalic vein.


Self-captured photo for prior oral ulcer.


Photo of psudo-folliculitis lesion.


Multiple Sections through CMR revealing normal myocardium with no evidence of endomyocardial fibrosis or scarring.


Diffuse thyroid hypervascularity.


Multiple nodules shown by 'x'.


Upsloping ST depression at J point in the inferior lead (de Winter sign) (red arrow) with positive T wave (yellow arrow) along with minimal ST elevation in aVR (black arrow).


(a) 99% thrombotic occlusion seen in the mid right coronary artery.


(b) After placement of drug-eluting stent.


ST elevation was not noted in serial electrocardiography. Post-post angioplasty resolution of De Winter pattern in inferior leads.


(A) Ischemia-free kidney transplant procedure. The diagram shows procurement, preservation, and implantation of the donor kidney without cessation of blood supply using normothermic machine perfusion.


(B) Normothermic machine perfusion device, Liver Assist (Organ Assist, Groningen, the Netherlands).


(C) Donor kidney circuit on the organ reservoir of the NMP device.


Normothermic machine perfusion and allograft viability. (A) Arterial flow rates and pressure.


Normothermic machine perfusion and allograft viability. (B) Creatinine (Crea) and urea concentration in the perfusate.


Normothermic machine perfusion and allograft viability. (C) Volume of urine production during machine perfusion.


Normothermic machine perfusion and allograft viability. (D) pH values and specific gravity levels of the urine produced before procurement, during machine perfusion, and post-reperfusion.


Initial presenting electrocardiogram: sinus rhythm with premature atrial and ventricular contractions, ST Elevation and Q waves in II, III, and aVF and tall R wave in V2 consistent with infero-post wall MI, STEMI.


Right coronary artery (RCA) pre-intervention revealing 90% occlusion of the mid RCA with thrombus formation.


Right coronary artery (RCA) after bare metal implantation in the mid RCA.