case_images: PMC9569230_01
case_images: First endomyocardial biopsy posttransplant demonstrating moderate acute cellular rejection with mildly diffuse lymphocytic infiltrates and focal myocardial ischemic injury.
case_images: CRIC2022-2054727.001.jpg
case_images: PMC9569230_01_CRIC2022-2054727.001.jpg
case_images: fig1
case_images: Her first endomyocardial biopsy on POD 12 revealed grade 2R approaching 3R rejection (Figures 1 and 2).
case_images: Close up image showing cardiac myocytes surrounded by dense collections of inflammatory cells (white arrow) and focal capillaritis (black arrow), consistent with grade 2R (borderline 3R) rejection.
case_images: CRIC2022-2054727.002.jpg
case_images: PMC9569230_01_CRIC2022-2054727.002.jpg
case_images: fig2
case_images: Her first endomyocardial biopsy on POD 12 revealed grade 2R approaching 3R rejection (Figures 1 and 2).
case_images: Fluoroscopy images at the time of endomyocardial biopsy demonstrating residual medications at the distal end of the esophagus (circle).
case_images: CRIC2022-2054727.003.jpg
case_images: PMC9569230_01_CRIC2022-2054727.003.jpg
case_images: fig3
case_images: Fluoroscopy at the time of follow-up biopsy revealed undigested pills in her esophagus and narrowing at the distal end (Figure 3).
case_images: Barium swallow study demonstrating achalasia. There is significant narrowing at the lower esophageal sphincter (white arrow) with pooling of contrast in the distal esophagus (black arrow) and markedly delayed transit of contrast into the stomach.
case_images: CRIC2022-2054727.004.jpg
case_images: PMC9569230_01_CRIC2022-2054727.004.jpg
case_images: fig4
case_images: This led to a barium swallow series (Figure 4), which confirmed the diagnosis of achalasia as the etiology for her acute rejection.