case_images: PMC7461343_01
case_images: Electrocardiogram demonstrated diffuse T wave inversions (Asterisk) in the right precordial leads (V1-4) and the inferior leads (II, III, aVF)
case_images: 40885_2020_150_Fig1_HTML.jpg
case_images: PMC7461343_01_40885_2020_150_Fig1_HTML.jpg
case_images: Fig1
case_images: An electrocardiogram showed T wave inversions in the inferior and precordial leads (Fig. 1).
case_images: Chest computed tomography (CT) scan with contrast showing multifocal thromboemboli (White Arrow) in both pulmonary arteries (a and b). Repeated CT scan performed six months after anticoagulation therapy showing complete resolution of the thromboemboli of the main branches of both pulmonary arteries (c and d)
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case_images: PMC7461343_01_40885_2020_150_Fig2_HTML.jpg
case_images: Fig2
case_images: Chest computed tomography (CT) showed massive PTE in both central pulmonary arteries and diffuse goiter (Fig. 2a, b). At a 6-month follow up visit, PTE and pulmonary hypertension had disappeared (Fig. 2c, d) but the patient still had a partial protein S deficiency.
case_images: Transthoracic echocardiographic (TTE) findings. a Parasternal short axis view on TTE performed on admission showing flattening of the interventricular septum (D-shaped left ventricle (LV): White Arrow). b Apical-four-chamber view on TTE performed on admission showed marked right ventricular (RV) dilatation (White Arrow). c Continuous wave Doppler echocardiographic study performed on admission. Pulmonary artery systolic pressure (64 mmHg) was calculated using maximum velocity of the tricuspid regurgitation jet (Vmax = 3.3 m/sec) and estimated right atrial pressure (20 mmHg). d Parasternal short axis view on TTE performed 3 months after anticoagulation therapy showing normalization of RV size and disappearance of the D-shaped LV. e Repeated TTE performed 3 months after anticoagulation therapy showed normalization of RV cavity with improved systolic function. f Continuous wave Doppler echocardiographic study performed 3 months after anticoagulation therapy. Pulmonary artery systolic pressure was normalized using maximum velocity of the tricuspid regurgitation jet (Vmax = 1.9 m/sec)
case_images: 40885_2020_150_Fig3_HTML.jpg
case_images: PMC7461343_01_40885_2020_150_Fig3_HTML.jpg
case_images: Fig3
case_images: An echocardiogram showed severe pulmonary hypertension (right ventricular systolic pressure (RVSP) = 64 mmHg), and a dilated RV, right atrium and main pulmonary artery (Fig. 3a-c). A follow-up echocardiogram obtained 3 months after anticoagulation therapy demonstrated normal dimensions and systolic function of the RV and disappearance of the D-shaped left ventricle (LV) (Fig. 3d-f).
case_images: Ultrasonography of thyroid on admission (a) showed more hypoechoic and enlarged thyroid gland (White Asterisk) but 6-month follow-up ultrasonography (b) showed normal sized thyroid gland
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case_images: PMC7461343_01_40885_2020_150_Fig4_HTML.jpg
case_images: Fig4
case_images: After thyrotoxicosis was treated with methimazole for a month, a euthyroid state was achieved and the goiter decreased to a normal size (Fig. 4).