Active paradoxical and pulmonary emboli in a first trimester pregnancy.

Capturing a paradoxical embolism in real-time has been a challenge in recent literature. We present the unique case of a 33-year-old, G3P2 female at 8 weeks gestation presenting with dyspnea. An active thrombus through an undiagnosed patent foramen ovale was found requiring emergent surgical intervention with a positive outcome. The presence of a deep vein thrombosis, inferior vena caval thrombus, patent foramen ovale, and pulmonary artery thrombi was contemporarily documented. To our knowledge, there is minimal literature with this presentation.

Chronic Anthracycline-related Myocarditis Presenting as Diffuse Myocardial Calcification.

In the setting of cardio-oncology, evaluation for myocarditis is a growing indication for cardiovascular magnetic resonance (CMR). Treatment-related side effects of cancer therapies comprise the majority of myocarditis cases in cardio-oncology, and these are often secondary to anthracyclines and even the newer class of immune checkpoint inhibitors. Cardiotoxicity from cancer therapy represents an increasingly recognized etiology of myocarditis and when detected, warrants prompt management changes. The conventional CMR evaluation for myocarditis includes modules for the left ventricular structure and function, early gadolinium enhancement, and late gadolinium enhancement. Newer CMR sequences including native T1 mapping and extracellular volume fraction offer improvement in diagnostic accuracy from conventional CMR methods. We present a case of subacute/ chronic myocarditis related to anthracycline therapy 4 months prior that was diagnosed only after incidental diffuse myocardial calcifications on pre-treatment computed tomography raised suspicion.