case_images: PMC11324266_01
case_images: First ECG demonstrating sinus rhythm and tachycardia of 100 beats per minute with low voltage complexes.
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case_images: F1
case_images: The electrocardiogram on presentation showed sinus rhythm and tachycardia of 100 beats per minute with low voltage complexes (Fig. 1).
case_images: Sagittal and coronal view of the CT chest without contrast demonstrated moderate to large PerF, right pleural effusion, and a posteriorly layering component with multiple lymphadenopathies.
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case_images: PMC11324266_01_cro-2024-0017-0001-540183_F02.jpg
case_images: F2
case_images: Therefore, computer tomography of the chest (CT chest) demonstrated moderate to large PerF, right pleural effusion, and a posteriorly layering component with multiple lymphadenopathies (Fig. 2).
case_images: Second ECG showing the new onset of atrial fibrillation (Afib) with rapid ventricular response.
case_images: cro-2024-0017-0001-540183_F03.jpg
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case_images: F3
case_images: During his stay at ED, the patient developed persistent tachycardia; therefore, an electrocardiogram (Fig. 3) was performed, showing atrial fibrillation with rapid ventricular response, therefore prompted an echocardiogram showing a large PerF collapsing the right atrium, an ejection fraction of 56%, and moderate left ventricular hypertrophy; furthermore, the patient was tachycardic during the test (Fig. 4).
case_images: Histopathology showed PDL1 70%, tumor mutational burden was high 14 Muts/Mb, MS stable with IHC + CK7 and Ber EP4, negative p40, TTF1, CK20, CALR, Napsin A.
case_images: cro-2024-0017-0001-540183_F05.jpg
case_images: PMC11324266_01_cro-2024-0017-0001-540183_F05.jpg
case_images: F5
case_images: Histopathology (Fig. 5) showed PDL1 70%, tumor mutational burden was high 14 Muts/Mb, MS stable with IHC + CK7 and Ber EP4, negative p40, TTF1, CK20, CALR, Napsin A.