case_images: PMC11251791_01
case_images: (a) Two prominent ear creases on the ears. VC-EF, vertical creases dividing earlobe and face (including right VC-EF and left VC-EF); CC-NEH, crossing creases not originated from ear hole (including right CC-NEH and left CC-NEH). (b) The right CC-NEH and bilateral VC-EF were found on our patient's ears.
case_images: CRIC2024-3766536.001.jpg
case_images: PMC11251791_01_CRIC2024-3766536.001.jpg
case_images: fig1
case_images: During the physical examination, we found the presence of FS in the patient's right ear, while the presence of vertical creases dividing earlobe and face (VC-EF) was found in both ears (Figure 1).
case_images: The initial electrocardiogram (ECG) revealed ST-segment elevation (STE) in leads II, III, and aVF with reciprocal depression in leads I, aVL, and V1-V4. The ratio of sum of ST-segment depression (STD) in leads V1-V3/sum of STE in leads II, III, and aVF < 1.
case_images: CRIC2024-3766536.002.jpg
case_images: PMC11251791_01_CRIC2024-3766536.002.jpg
case_images: fig2
case_images: The ratio of sum of ST-segment depression (STD) in leads V1-V3/sum of STE in leads II, III, and aVF < 1 supports right coronary artery (RCA) (Figure 2).
case_images: Coronary angiography (CAG) showed a slit-like contrast defect in the proximal right coronary artery (RCA), with stenosis and occlusion in the distal segment. Moreover, diffuse lesions were observed in the proximal left anterior descending (LAD) artery, with 50%-60% stenosis at the most severe site. Approximately 40%-50% stenosis in the proximal left circumflex artery (LCX) and a stent shadow in the middle LCX with no obvious stenosis in the stent can be seen (the arrows refer to coronary stenosis).
case_images: CRIC2024-3766536.003.jpg
case_images: PMC11251791_01_CRIC2024-3766536.003.jpg
case_images: fig3
case_images: Approximately 40%-50% stenosis in the proximal left circumflex (LCX) artery and a stent shadow in the middle LCX with no obvious stenosis in the stent can be seen (Figure 3).
case_images: Repeat coronary angiography (CAG) after the right coronary artery percutaneous coronary intervention (PCI). Blood flow recovery at occlusion of the right coronary artery (RCA), and the thrombolysis in myocardial infarction blood flow in the distal right coronary artery was Grade 3. (a) The locations of the four delivered stents were marked in red arrows. (b) The middle segment of the RCA under RAO-CRA projection after PCI.
case_images: CRIC2024-3766536.004.jpg
case_images: PMC11251791_01_CRIC2024-3766536.004.jpg
case_images: fig4
case_images: RCA. Repeat angiography showed blood flow recovery at occlusion of the RCA, and the thrombolysis in myocardial infarction blood flow in the distal RCA was Grade 3(Figure 4).
case_images: The postprocedural electrocardiogram (ECG) showed leads II, III, and aVF fell back and necrotic Q wave appeared, while leads I, aVL, and V1-V4 returned to the equipotential line.
case_images: CRIC2024-3766536.005.jpg
case_images: PMC11251791_01_CRIC2024-3766536.005.jpg
case_images: fig5
case_images: The postprocedural ECG showed that leads II, III, and aVF fell back and necrotic Q wave appeared, while leads I, aVL, and V1-V4 returned to the equipotential line (Figure 5).