Asunto(s)
Endocarditis Bacteriana , Endocarditis no Infecciosa , Endocarditis , Sarcoma , Humanos , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Endocarditis no Infecciosa/diagnóstico , Endocarditis no Infecciosa/etiología , Endocarditis/diagnóstico , Prótesis e Implantes , Sarcoma/diagnósticoRESUMEN
Marantic endocarditis is a rare condition associated with autoimmune disease, malignancy, and hypercoagulable states. It is characterized by sterile friable vegetations composed of fibrin and platelets that confer a high risk of systemic embolism. Here we showcase imaging that led to the diagnosis of an interesting case of marantic endocarditis secondary to metastatic malignancy.
Asunto(s)
Adenocarcinoma del Pulmón , Endocarditis no Infecciosa , Endocarditis , Neoplasias Pulmonares , Humanos , Adenocarcinoma del Pulmón/complicaciones , Endocarditis/diagnóstico , Endocarditis/diagnóstico por imagen , Endocarditis no Infecciosa/etiología , Endocarditis no Infecciosa/complicaciones , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
BACKGROUND: Nonbacterial thrombotic endocarditis is a rare complication of prothrombotic states such as neoplasms that can cause valvular dysfunction and life-threatening complications. Nonbacterial thrombotic endocarditis usually affects the left-sided valves; however, only a minority of cases involving the tricuspid valve have been reported in medical literature. CASE PRESENTATION: The current report describes trivalvular involvement by nonbacterial thrombotic endocarditis in a 54-year-old Azeri female patient with metastatic colorectal carcinoma. This case underlines the necessity of evaluating nonbacterial thrombotic endocarditis as a possible consequence in cancer patients. When thromboembolic events are found in the presence of a hypercoagulable state (such as malignancy) and no growth on blood cultures, nonbacterial thrombotic endocarditis could be suspected as the cause. CONCLUSION: It is critical to achieve early diagnosis in such a setting to initiate treatment plans and prevent further complications rapidly.
Asunto(s)
Adenocarcinoma , Neoplasias del Colon , Endocarditis no Infecciosa , Endocarditis , Humanos , Femenino , Persona de Mediana Edad , Adenocarcinoma/complicaciones , Adenocarcinoma/patología , Neoplasias del Colon/complicaciones , Endocarditis no Infecciosa/etiología , Endocarditis no Infecciosa/complicaciones , Válvula Tricúspide/diagnóstico por imagen , Endocarditis/complicacionesRESUMEN
Non-bacterial thrombotic endocarditis (NBTE) is a rare, often asymptomatic, condition. A 55-year-old woman presented with hemiparesis, facial palsy and chest pain. After urgent investigation, she was referred as a case of type A aortic dissection complicated by tamponade, myocardial infarction and stroke. Review of her imaging identified haemopericardium but no dissection, and emergency surgery proceeded considering her unstable condition. She underwent an emergency repair of left-ventricular free-wall rupture and excision of an aortic valve vegetation. Postoperative investigations confirmed a diagnosis of NBTE in the setting of a plexiform neurofibroma, and she was discharged 9 weeks later with residual neurological symptoms. This case poses a previously unreported acute presentation of NBTE and highlights the complexities in its diagnosis and management.
Asunto(s)
Endocarditis no Infecciosa , Infarto del Miocardio , Accidente Cerebrovascular , Humanos , Femenino , Persona de Mediana Edad , Endocarditis no Infecciosa/etiología , Infarto del Miocardio/etiología , Válvula Aórtica , Accidente Cerebrovascular/etiologíaAsunto(s)
Endocarditis no Infecciosa , Neoplasias Hepáticas , Neoplasias Pancreáticas , Endocarditis no Infecciosa/complicaciones , Endocarditis no Infecciosa/etiología , Humanos , Infarto/complicaciones , Neoplasias Hepáticas/complicaciones , Neoplasias Pancreáticas/complicaciones , Neoplasias PancreáticasRESUMEN
BACKGROUND: Nonbacterial thrombotic endocarditis is characterized by the presence of organized thrombi on cardiac valves, often associated with hypercoagulable states. There is a paucity of data regarding the predictors of mortality in patients with nonbacterial thrombotic endocarditis. Our primary aim was to identify predictors of in-hospital mortality in patients with nonbacterial thrombotic endocarditis. METHODS: A systematic literature review of all published cases and case series was performed until May 2018 according to Preferred Reporting Items for Systematic Review and Meta-analyses statement guidelines. We applied random forest machine learning model to identify predictors of in-patient mortality in patients with nonbacterial thrombotic endocarditis. RESULTS: Our search generated a total of 163 patients (mean age, 46 ± 17 years; women, 69%) with newly diagnosed nonbacterial thrombotic endocarditis. The in-hospital mortality rate in the study cohort was 30%. Among the patients who died in the hospital, initial presentation of pulmonary embolism (12.2 vs. 2.6%), splenic (38.7 vs. 10.5%), and renal (40.8 vs. 9.6%) infarcts were higher compared to patients alive at the time of discharge. Higher rates of malignancy (71.4 vs. 39.4%, P = .0003) and lower rates of antiphospholipid syndrome (8.1 vs. 48.2%, P = .0001) were noted in deceased patients. Random forest machine learning analysis showed that older age, presence of antiphospholipid syndrome, splenic infarct, renal infarct, peripheral thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality. CONCLUSION: Patients admitted with nonbacterial thrombotic endocarditis have a high rate of in-hospital mortality. Factors including older age, presence of antiphospholipid syndrome, splenic/renal infarct, lower limb thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality in patients with nonbacterial thrombotic endocarditis.
Asunto(s)
Síndrome Antifosfolípido , Endocarditis no Infecciosa , Insuficiencia de la Válvula Mitral , Infarto del Miocardio , Embolia Pulmonar , Tromboembolia , Adulto , Síndrome Antifosfolípido/complicaciones , Endocarditis no Infecciosa/etiología , Endocarditis no Infecciosa/patología , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Infarto del Miocardio/complicaciones , Embolia Pulmonar/complicacionesRESUMEN
Non-bacterial thrombotic endocarditis (NBTE) is a rare condition related to a state of hypercoagulability in advanced neoplastic disease. Most of the time, arterial thromboembolic event precedes the diagnosis of NBTE. We report here a case of NBTE responsible for multiple ischaemic strokes, which leads to the diagnosis of metastatic pancreatic adenocarcinoma. Aortic and mitral valvular regurgitations secondary to NBTE appeared within 6 weeks despite therapeutic anticoagulation with direct oral anticoagulant (DOAC) in stroke prevention of paroxysmal atrial fibrillation. Bivalvular regurgitations resolved 8 weeks after therapeutic switch to low-molecular-weight heparin (LMWH) and chemotherapy. DOACs are a possible alternative to LMWH for the prevention of venous thromboembolism in patients with active neoplasia. There is a lack of evidence for a clinical efficiency for the prevention of arterial thromboembolism in NBTE. We propose here a short review of the efficacy of anticoagulant therapy for the prevention of arterial thromboembolism in NBTE.
Asunto(s)
Adenocarcinoma , Endocarditis no Infecciosa , Neoplasias Pancreáticas , Adenocarcinoma/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Endocarditis no Infecciosa/diagnóstico , Endocarditis no Infecciosa/tratamiento farmacológico , Endocarditis no Infecciosa/etiología , Heparina , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/tratamiento farmacológicoAsunto(s)
Síndrome Antifosfolípido/diagnóstico , Endocarditis no Infecciosa/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Anticoagulantes/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/tratamiento farmacológico , Disartria/diagnóstico , Disartria/etiología , Ecocardiografía Transesofágica/métodos , Endocarditis no Infecciosa/tratamiento farmacológico , Endocarditis no Infecciosa/etiología , Parálisis Facial/diagnóstico , Parálisis Facial/etiología , Humanos , Comunicación Interdisciplinaria , Accidente Cerebrovascular Isquémico/complicaciones , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Warfarina/uso terapéuticoRESUMEN
A 69-year-old Chinese man presented with exertional dyspnoea and subjective left upper limb weakness. Initial clinical impressions were community-acquired pneumonia and cerebrovascular accident. Further imaging studies revealed an incidental mitral valve vegetation and left lung upper lobe nodule likely a lung malignancy with possible lymphangitis carcinomatosis. Appropriate empirical antibiotic treatment for infective endocarditis was instituted early in admission, but multiple blood cultures were negative. The patient progressively developed worsening neurological dysfunction and subconjunctival haemorrhage from recurrent embolic complications despite empirical antimicrobial treatment. Histology finally revealed lung adenocarcinoma after delay in obtaining biopsy due to high procedural risk from recurrent stroke. Unfortunately, before the patient could undergo any systemic oncology treatment, he deteriorated with type I respiratory failure from obstructive pneumonia and eventually demised. Important lessons include the need to consider non-bacterial thrombotic endocarditis as a differential in the appropriate clinical context followed by anticoagulation with systemic treatment as early as possible.
Asunto(s)
Adenocarcinoma del Pulmón , Endocarditis Bacteriana , Endocarditis no Infecciosa , Endocarditis , Neoplasias Pulmonares , Adenocarcinoma del Pulmón/tratamiento farmacológico , Anciano , Endocarditis/complicaciones , Endocarditis/diagnóstico , Endocarditis/tratamiento farmacológico , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis no Infecciosa/diagnóstico por imagen , Endocarditis no Infecciosa/etiología , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Válvula MitralRESUMEN
A 66-year-old Caucasian man was initially admitted with a metastatic small cell lung carcinoma, hyponatraemia and obstructive pneumonia. His transthoracic echocardiogram (TTE) was normal. Ten days after admission, he was diagnosed with a non-ST segment elevation myocardial infarction (MI). Both a repeated TTE and a transoesophageal echocardiogram identified thickened, myxomatous mitral valve leaflet tips with small, mobile masses identified as vegetations, and new, eccentric, severe mitral regurgitation. Subsequent cardiac catheterisation recorded thrombotic occlusion of the right coronary artery. Successful coronary thrombectomy was carried out, but the patient died. A diagnosis of non-bacterial thrombotic endocarditis leading to coronary embolisation and MI was made. The clinical course and treatment choices are discussed.
Asunto(s)
Endocarditis no Infecciosa , Neoplasias Pulmonares , Carcinoma Pulmonar de Células Pequeñas , Anciano , Endocarditis no Infecciosa/diagnóstico por imagen , Endocarditis no Infecciosa/etiología , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Válvula Mitral , Carcinoma Pulmonar de Células Pequeñas/complicaciones , TrombectomíaRESUMEN
BACKGROUND: Nonbacterial thrombotic endocarditis, or marantic endocarditis, is rare. Contemporary data on the etiology, echocardiographic evaluation, and management of nonbacterial thrombotic endocarditis are limited. METHODS: A single-center retrospective cohort study was performed. Electronic medical records and echocardiographic records were searched for patients ages ≥18 years with a confirmed diagnosis of nonbacterial thrombotic endocarditis between January 1999 and November 2019. Demographic, echocardiographic, and management data were collected. RESULTS: Of 600,577 transthoracic echocardiograms (TTEs) and 89,264 transesophageal echocardiograms (TEEs), 42 patients had nonbacterial thrombotic endocarditis (mean age: 54 ± 14.5 years; 66.7% were female). The median duration of follow-up was 8.2 (interquartile range 3.3-24.4) months. Seventeen patients (40.5%) had malignancy, 33.3% had systemic lupus erythematosus, and 35.7% had antiphospholipid antibody syndrome. Stroke was the most common presentation (59.5%). TTE enabled the diagnosis in 19 cases (45.2%), compared with TEE, which identified the condition in 33 of 34 (97.1%) cases in which it was utilized. Three-dimensional echocardiography was performed in 17 TEEs. The most common valves involved were mitral (61.9%), and aortic (23.8%) valves. Thirty-two patients were managed with anticoagulation. Ten patients underwent surgery. Sixteen (38.1%) patients died, most of whom had a diagnosis of advanced malignancy. CONCLUSION: In a contemporary 20-year cohort, TTE and TEE played important roles in diagnosis, with superior diagnostic performance of TEE for nonbacterial thrombotic endocarditis. Mortality was high, and advanced malignancy portended a worse prognosis. Management in most cases was therapeutic anticoagulation. In select cases, surgery provided favorable outcomes.
Asunto(s)
Endocarditis no Infecciosa , Adulto , Anciano , Estudios de Cohortes , Ecocardiografía , Endocarditis no Infecciosa/tratamiento farmacológico , Endocarditis no Infecciosa/etiología , Endocarditis no Infecciosa/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 66-year-old woman with a remote history of breast cancer and prior tobacco use presented to the hospital with chest pain. She was found to have an elevated troponin consistent with a diagnosis of a non-ST segment elevation myocardial infarction (NSTEMI). A left heart catheterisation revealed non-obstructive coronary disease, and subsequent transthoracic and transoesophageal echocardiograms demonstrated vegetations on both the mitral and aortic valves. Multiple blood cultures showed no growth raising suspicion for non-bacterial thrombotic endocarditis (NBTE). A CT of the chest, abdomen and pelvis was obtained that was consistent with metastatic pancreatic cancer. Her hospital course was complicated by recurrent embolic strokes leading to a rapid clinical deterioration. As a result, she was transitioned to comfort measures and passed away shortly thereafter. To our knowledge, this is the first reported case of an NSTEMI as the initial presentation of NBTE due to underlying malignancy.
Asunto(s)
Neoplasias de la Mama/complicaciones , Endocarditis no Infecciosa/etiología , Infarto del Miocardio sin Elevación del ST/etiología , Neoplasias Pancreáticas/secundario , Accidente Cerebrovascular/etiología , Anciano , Válvula Aórtica/patología , Neoplasias de la Mama/patología , Dolor en el Pecho/etiología , Ecocardiografía Transesofágica , Endocarditis no Infecciosa/diagnóstico , Resultado Fatal , Femenino , Humanos , Válvula Mitral/patología , Infarto del Miocardio sin Elevación del ST/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Troponina/sangreRESUMEN
Nonbacterial thrombotic endocarditis (NBTE) of bioprosthetic valves is extremely rare. We report a 67-year-old lady with early bioprosthetic "failure" that at reoperation was proven to be NBTE. The choice of a prosthesis in this condition may have implications for patients' late clinical course.
Asunto(s)
Bioprótesis/efectos adversos , Endocarditis no Infecciosa/etiología , Endocarditis no Infecciosa/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Falla de Prótesis , Anciano , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Calcinosis/cirugía , Ecocardiografía Transesofágica , Endocarditis no Infecciosa/diagnóstico por imagen , Endocarditis no Infecciosa/patología , Femenino , Humanos , Reoperación , ReimplantaciónAsunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Neoplasias de los Conductos Biliares/complicaciones , Conductos Biliares Intrahepáticos , Enfermedades Cerebelosas/etiología , Colangiocarcinoma/complicaciones , Endocarditis no Infecciosa/etiología , Accidente Cerebrovascular/etiología , Trombosis de la Vena/etiología , Corticoesteroides/uso terapéutico , Adulto , Antineoplásicos/uso terapéutico , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/tratamiento farmacológico , Neoplasias de los Conductos Biliares/patología , Bioprótesis , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/tratamiento farmacológico , Colangiocarcinoma/secundario , Ecocardiografía Transesofágica , Endocarditis no Infecciosa/diagnóstico por imagen , Endocarditis no Infecciosa/cirugía , Femenino , Lóbulo Frontal , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Metástasis Linfática , Imagen por Resonancia Magnética , Lóbulo Occipital , Cuidados Paliativos , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Tomografía Computarizada por Rayos XRESUMEN
Nonbacterial thrombotic endocarditis (NBTE) refers to noninfectious vegetations of the heart valves. It is commonly associated with malignancy and autoimmune diseases like systemic lupus erythematosus, Rheumatoid arthritis. Herein, we present Non-bacterial thrombotic endocarditis and Disseminated intravascular coagulation as the initial manifestations of prostate cancer. A 50-yearold gentleman, known case of hypertension and diabetes, presented with a history of recurrent ischaemic strokes, STEMI and a recent diagnosis of infective endocarditis. He had been taking antibiotics for the past 20 days without any improvement. Negative blood cultures in the presence of vegetations on repeat echocardiography led to a suspicion of NBTE. Laboratory investigations were suggestive of Disseminated intravascular coagulation. CT abdomen and pelvis demonstrated enlarged prostate with enlarged pelvic lymph nodes. Prostate specific antigen was raised at more than 100ng/ml. A bone scan showed extensive metastasis. The patient was started on GnRH analogue and bicalutamide. His Disseminated intravascular coagulation resolved and he was subsequently started on anticoagulants. The valvular lesions diminished without any residual dysfunction.
Asunto(s)
Coagulación Intravascular Diseminada , Endocarditis no Infecciosa , Neoplasias de la Próstata , Coagulación Intravascular Diseminada/diagnóstico , Coagulación Intravascular Diseminada/etiología , Ecocardiografía , Endocarditis no Infecciosa/diagnóstico , Endocarditis no Infecciosa/etiología , Endocarditis no Infecciosa/patología , Válvulas Cardíacas/diagnóstico por imagen , Válvulas Cardíacas/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/diagnósticoRESUMEN
Marantic endocarditis is a rare non-infectious endocarditis that mostly affects the aortic and mitral valves. It is often an autopsy finding that is most commonly seen in advanced malignancies thought to be due to a hypercoagulable state. When diagnosed antemortem, it typically presents with signs and symptoms of embolisation. We report a case of a 44-year-old Caucasian man with marantic endocarditis secondary to metastatic small cell lung cancer. Our patient presented with a short history of lower back pain with no signs/symptoms of embolisation, and a pansystolic murmur on initial physical examination. Serial blood cultures were negative and transthoracic echocardiography revealed vegetation on the posterior leaflet of the mitral valve. Further imaging in the form of MRI spine and CT thorax/abdomen/pelvis showed pulmonary lesions with liver and bony metastasis. Subsequent image-guided biopsy confirmed metastatic small cell lung cancer of T1N2M1c grade, which was treated with palliative chemotherapy and radiotherapy.
Asunto(s)
Endocarditis no Infecciosa/etiología , Neoplasias Pulmonares/complicaciones , Carcinoma Pulmonar de Células Pequeñas/complicaciones , Adulto , Diagnóstico Diferencial , Humanos , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética , Masculino , Metástasis de la Neoplasia , Tomografía Computarizada por Rayos XAsunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Válvula Aórtica/patología , Enfermedad de Crohn/diagnóstico , Endocarditis no Infecciosa/etiología , Pericarditis/etiología , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/patología , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/patología , Endocarditis no Infecciosa/diagnóstico , Endocarditis no Infecciosa/patología , Humanos , Masculino , Pericarditis/diagnóstico , Pericarditis/patologíaRESUMEN
Nonbacterial thrombotic endocarditis (NBTE) associated with malignancy is rare; its infrequency and similarity to other diagnoses make it a significant diagnostic challenge. A 63-year-old woman on rivaroxaban for prior deep vein thrombosis presented with left upper extremity weakness and left facial droop with imaging demonstrating multiple strokes. Echocardiograms revealed mitral and aortic valve vegetations. The patient was switched to apixaban and started on vancomycin and ceftriaxone for presumed culture-negative endocarditis. Despite continuing apixaban, her hospital course was complicated by new acute embolic infarcts. Workup confirmed non-mucinous metastatic biliary adenocarcinoma. The patient was placed on a heparin drip then switched to low molecular weight heparin without further embolic events and was discharged to a rehabilitation facility in stable condition with plans for chemotherapy as an outpatient. These clinical, imaging, and histologic findings were consistent with a rare case of NBTE associated with primary non-mucinous gallbladder malignancy complicated by recurrent strokes in which direct oral anticoagulants did not provide adequate anticoagulation.