case_images: PMC11683360_01
case_images: (A) Electrocardiogram at presentation showing complete heart block. (B) An electrocardiogram done a few days before the presentation showing a very prolonged PR interval (400 ms) with 1:1 atrioventricular conduction.
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case_images: An electrocardiogram (ECG) revealed a CHB with ventricular escape rhythm at the rate of 50 b.p.m. (Figure 1A). ECG that the patient had done a few days before the current presentation revealed prolonged PR with 1:1 atrioventricular (AV) conduction (Figure 1B). Echocardiography was done, which revealed normal left ventricular (LV) function and normal valvular function; however, the anterior mitral leaflet was found to be thickened with no vegetations (Figure 2).
case_images: Echocardiographic images in a diastolic frame showing a thickened anterior mitral leaflet in diastole (A) and on the right side a systolic frame (B).
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case_images: PMC11683360_01_ytae657f2.jpg
case_images: ytae657-F2
case_images: ECG that the patient had done a few days before the current presentation revealed prolonged PR with 1:1 atrioventricular (AV) conduction (Figure 1B). Echocardiography was done, which revealed normal left ventricular (LV) function and normal valvular function; however, the anterior mitral leaflet was found to be thickened with no vegetations (Figure 2).
case_images: (A) A computed tomography section at the level of pulmonary artery bifurcation showing soft tissue thickening around the ascending aorta (see the arrow). In (B), the cardiac computed tomography section in the cardiac long axis shows fluorodeoxyglucose uptake in the basal interventricular septum and over the anterior mitral leaflet. In (C), the arch of the aorta shows avid fluorodeoxyglucose in the aortic wall. Computed tomography scan as shown in (D) shows subarachnoid haemorrhage with hyperintense cisterns. (E) A computed tomography angiogram of the right posterior circulation with a large aneurysm (see the arrow) in the vertebral artery. (F) Electrocardiogram shows monomorphic ventricular tachycardia.
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case_images: PMC11683360_01_ytae657f3.jpg
case_images: ytae657-F3
case_images: A whole body positron emission tomography (PET) scan was done for the patient in view of suspicion of sarcoidosis vs. vasculitis with unusual clinical features, which revealed thickened mitral leaflet with active fluorodeoxyglucose (FDG) uptake, which involved the ascending aorta, the arch, and the descending aorta up to the renal arteries suggestive of aortitis (Figure 3A-C). CT scan of the brain revealed subarachnoid haemorrhage (SAH) (Figure 3D). Computed tomography angiography of the brain revealed a large aneurysm of the V4 segment of the right vertebral artery (Figure 3E).