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She had left bundle branch block and aortic insufficiency with normal ejection fraction on 2-dimensional echocardiogram, none of which explained her symptoms. A CT coronary angiogram showed no obstructive coronary artery disease Coronary Artery Disease Reporting and Data System category 1. Complete occlusion of the left superior pulmonary vein was, however, noted at its origin. Lung perfusion scintigraphy was obtained to evaluate differential perfusion. Metastasis to the pancreas from differentiated thyroid carcinoma is rare. A new panc