Anomalies in the ST segment, especially ST-segment elevation, require the ruling out of possible etiologies such as myocardial ischemia or pericarditis. However, other noncardiac disorders such as increases in intra-abdominal and intrathoracic pressure, may cause ST-segment elevation as well and should be considered as possible etiologies due to the poor prognosis they imply in the clinical evolution of the patient. This is especially important in critically ill patients. In this respect, we herein present a case in which the increase in intra-abdominal pressure and thoracic cavity elevation due to gastric and intestinal distension, which was not present in the first CT, provoked a cardiac and coronary compression resulting in T-shaped dome wave, a QT prolongation and ST segment elevation in the inferior leads of the electrocardiogram, the patient did not present at the time of admission, ruling out other possible etiologies such as ionic imbalance or acute ischemia.

A 61-year-old man who presented with syncope for several minutes recovered spontaneously. On admission, the patient was asymptomatic, and the initial physical examination was normal. The first complementary tests (ECG, blood laboratory, chest radiography, cerebral computed tomography, and pulmonary scintigraphy) showed no abnormalities.A transthoracic echocardiogram showed a worm-like mass in the right atrium not clearly attached to the heart wall. Unfractionated heparin was initiated with the initial suspicion of intracardiac thrombus. Thirty-six hours later, a transesophageal echocardiography revealed a 4ϫ8-mm mobile mass on the eustachian valve (Movie I), the size of which was decreased considerably with respect to the previous study after an intensive anticoagulation therapy. This finding supported the initial diagnosis of intracardiac thrombosis, and oral anticoagulation with warfarin was begun. After discharge (3 and 6 months later), 2 new transesophageal studies were made that provided evidence of the complete disappearance of the eustachian valve thrombus (Movies II and III).The eustachian valve in adult is an embryological remainder of the fetal venous sinus valve. This structure is located in the right atrium and is a common, not pathological, echocardiographic finding. It is known that in 4% to 18% of pulmonary embolisms, thrombi are discovered in the right side of the heart; however, their presence on the eustachian valve is very unusual. Only 3 cases have been reported with this finding: 2 patients in the context of pulmonary embolism and 1 who was asymptomatic. In the 3 cases, an aggressive treatment (fibrinolytic therapy or systemic anticoagulation) achieved complete thrombus lysis. DisclosuresNone.From the Echocardiography Unit of Cardiology Medical Service (J.E.-V.), Echocardiography Unit of Cardiology Medical Service (I.L.-B.), and Department of Internal Medicine (C.G.), Hospital Clínico Universitario "Lozano Blesa," Zaragoza, Spain.The online Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/118/13/e504/DC1.

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