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Case presentation
A 71-year-old man presented with a 2-months history of arrhythmia of undetermined cause, dysphagia, vomiting and 10 kg weight loss. The patient’s history was unremarkable except for multinodular goitre and hypertension. Laboratory exams did not demonstrate significant alterations, white cell count was 7.8×109/L (ref range: 4.0–10.0), haemoglobin 16.2 g/L (ref range: 12.0–15.0), platelet 281×109/L (ref range: 150–450), C reactive protein <0.05 mg/L (ref range: <5). Tumour markers were within normal range. An echocardiogram (figure 1) and gastroscopy (figure 2) were performed.
Question
What is the clinical problem?
Answer
A …
Footnotes
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Contributors MDS conceived of the presented idea. LG and SV drafted the manuscript. MVM and VP extrapolated and adapt the figures. VB and IB discussed the results and commented on the manuscript. MDS and CS revised and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CS is consultant for Medtronic, Pentax, Olympus, Norgine, Alfasigma, Anx Robotics. IB is consultant for Apollo endosurgery. Boston Scientific, Cook Medical, Pentax medical, EndoTools, Microtech, ERBE Elektromedizin. Research grant: Apollo Endosurgery, Erbe, EndoTools.
Provenance and peer review Not commissioned; externally peer reviewed.