A 53-year-old woman arrived at a Chinese emergency department with 24 hours of crushing chest pain and heavy sweating. She had no diabetes, normal cholesterol, and no significant medical history. Her high-sensitivity cardiac troponin I came back at 18.216 nanograms per milliliter, nearly 470 times the hospital's upper reference limit for women.
Then clinicians noticed her neck veins were distended while she lay flat, and that thick, non-pulsatile veins had surfaced across her chest and abdomen. Imaging explained why. Her right coronary artery had ballooned into a mass measuring roughly 15.6 centimeters at its longest dimension, pressing on her right atrium, right ventricle, and superior vena cava.
