case_images: PMC6158949_01
case_images: CT abdomen and pelvis without contrast demonstrating mild perihepatic ascites, diffuse low-attenuation of the liver likely due to active hepatocellular disease. Diffusely thickened gallbladder wall as demonstrated on abdominal ultrasound. Additional CT findings include a moderate amount of free fluid in the pelvis and a small right-sided pleural effusion. No obstructing renal calculus identified.
case_images: CRIM2018-3625139.001.jpg
case_images: PMC6158949_01_CRIM2018-3625139.001.jpg
case_images: fig1
case_images: There was diffuse low-attenuation of the liver and perihepatic ascites, a moderate amount of free fluid in the pelvis, and a small right-sided pleural effusion (Figure 1).
case_images: ECG obtained on day 3 exhibiting a heart rate of 60 bpm, a junctional rhythm, normal axis, and T wave inversions in V1 and V2.
case_images: CRIM2018-3625139.002.jpg
case_images: PMC6158949_01_CRIM2018-3625139.002.jpg
case_images: fig2
case_images: ECG revealed a rate of 60 bpm, a junctional rhythm, normal axis, and new T wave inversions in V1 and V2 (Figure 2).
case_images: ECG from the same patient in normal sinus rhythm. T wave inversions not evident in V1 and V2.
case_images: CRIM2018-3625139.003.jpg
case_images: PMC6158949_01_CRIM2018-3625139.003.jpg
case_images: fig3
case_images: An ECG without these abnormalities obtained prior is also shown (Figure 3).
case_images: Coronary CT angiogram image revealing normally positioned left anterior descending artery (LAD) without any evidence of coronary artery disease.
case_images: CRIM2018-3625139.004.jpg
case_images: PMC6158949_01_CRIM2018-3625139.004.jpg
case_images: fig4
case_images: A CT angiography of her coronaries revealed normal coronary arteries, aorta, and pericardium (Figures 4-7).
case_images: Coronary CT angiogram image revealing the distal segments and diagonal branches of LAD are normal without any evidence of coronary artery disease.
case_images: CRIM2018-3625139.005.jpg
case_images: PMC6158949_01_CRIM2018-3625139.005.jpg
case_images: fig5
case_images: A CT angiography of her coronaries revealed normal coronary arteries, aorta, and pericardium (Figures 4-7).
case_images: Coronary CT angiogram image revealing the circumflex is nondominant. The proximal segment and obtuse marginal branches are normal.
case_images: CRIM2018-3625139.006.jpg
case_images: PMC6158949_01_CRIM2018-3625139.006.jpg
case_images: fig6
case_images: A CT angiography of her coronaries revealed normal coronary arteries, aorta, and pericardium (Figures 4-7).
case_images: Coronary CT angiogram image revealing the right coronary artery arises normally from the right coronary cusp and is dominant without any evidence of coronary artery disease.
case_images: CRIM2018-3625139.007.jpg
case_images: PMC6158949_01_CRIM2018-3625139.007.jpg
case_images: fig7
case_images: A CT angiography of her coronaries revealed normal coronary arteries, aorta, and pericardium (Figures 4-7).
case_images: Trend of liver function tests and troponin obtained during hospital course. Day 1 is day of admission. Day 17 is outpatient follow-up.
case_images: CRIM2018-3625139.008.jpg
case_images: PMC6158949_01_CRIM2018-3625139.008.jpg
case_images: fig8
case_images: The patient continued to feel better, troponins began to trend down (Table 3), and hepatic indices improved (Figure 8).