History A 65-year-old woman presented to her primary care physician with a history of progressive abdominal pain mainly in the upper quadrants, nausea, and edema in the bilateral symmetric lower extremities. Other symptoms and use of medication or related drugs were denied. Physical examination findings were normal. The serum lactate dehydrogenase level was 302 U/L (5.04 μkat/L) (reference range, <247 U/L [4.12 μkat/L]), and all other laboratory data were within normal ranges. Electrocardiography and chest radiography revealed no abnormalities. The patient underwent contrast material-enhanced (100 mL of iomeprol [400 mg iodine per milliliter], Iomeron; Bracco Imaging) CT of the chest, abdomen, and pelvis; dynamic contrast-enhanced (13 mL of gadobenate dimeglumine, Multihance; Bracco Imaging) MRI of the chest and abdomen; and transthoracic echocardiography and cavography for further evaluation.