FIGURE 1.
ECG at the moment of the crisis.
Table 1.
Laboratory findings at admission to the Cardiology Department
| Laboratory finding | Value | Reference range |
|---|---|---|
| D-dimers | 3,240 ng/ml | < 500 ng/ml |
| Troponine | 49 | < 50 |
| NT-proBNP | 35,000 pg/ml | < 300 pg/ml |
| Glucose | 115 mg/dl | 70–110 mg/dl |
| Creatinine | 1.70 mg/dl Clearance 28.77 ml/min | 0.5–1.2 mg/dl |
| Urea | 29 mg/dl | 20–50 mg/dl |
| Potassium | 3.43 mmol/L | 3.5–5.1 mmol/L |
| C-reactive protein | 4.8 mg/dl | 0–1 mg/dl |
| Total protein | 5.9 g/dl | 6–8 g/dl |
| Albumin | 2.9 g/dl | 3.5–5.2 g/dl |
| Ferritin | 390 ng/ml | 10–300 ng/ml |
| Serum iron | 47 μg/dl | 50–175 μg/dl |
| Hemoglobin | 10 g/dl | 12–17 g/dl |
| Hematocrit | 31.2 g/dl | 36–52 g/dl |
| Lymphocytes | 19.2% | 20–40% |
| Erythrocyte sedimentation rate | 30 mm/h | 6–12 mm/h |
| International normalized ratio | 1.06 | 0.8–1.2 |
FIGURE 2.
A. Apical three-chamber view showing a left ventricular posterior wall pseudoaneurysm measuring 5.36 cm, with associated left pleural effusion. B. Color Doppler examination demonstrating communication between the left ventricular cavity and the pseudoaneurysm.
FIGURE 3.
Thoracic CT angiography showing a posterior wall left ventricular pseudoaneurysm, bilateral pleural effusion, and thrombus in the left atrial appendage. No signs of pulmonary thromboembolism are present.
FIGURE 4.
ECG showing significant bradycardia, interpreted as a vagal reaction secondary to the vomiting episode.
Table 2.
Paraclinical investigations on day 23 of hospitalization
| Laboratory finding | Value | Reference range |
|---|---|---|
| White blood cells | 16.67 × 109/L | 4–40 |
| Neutrophils | 82.9% | 50–75 |
| Lymphocytes | 10% | 20–40 |
| Hemoglobin | 11.8 g/dl | 12–17 |
| Ferritin | 530 ng/ml | 10–300 |
| C-reactive protein | 5.2 mg/dl | 0–1 |
| Creatinine | 1.81 mg/dl, eGFR 26.49 ml/min/1.73 m2 | 0.5–1.2 |
| Albumin | 3.3 g/dl | 3.5–5.2 |
| Glucose | 240 mg/dl | 70–110 |
| Total bilirubin | 0.57 mg/dl | <1 |
| Direct bilirubin | 0.02 mg/dl | <0.4 |
| Amylase | 26 U/L | 0–100 |
| Abdominal ultrasound | Dilated gallbladder with markedly thickened, echogenic walls and multiple gallstones. Liver with normal echogenicity and no focal lesions. No dilatation of the intrahepatic bile ducts. Portal vein and common bile duct of normal caliber. Pancreas, spleen, and kidneys within normal limits. | |