[Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series]. / Endocarditis trombótica no bacteriana: estudio clínico-patológico de una serie necrópsica.

INTRODUCTION AND OBJECTIVES: Nonbacterial thrombotic endocarditis (NBTE) is characterized by sterile platelet and fibrin deposition on cardiac valves. In this study, our aim was to investigate the clinicopathologic characteristics of patients diagnosed with NBTE at the 12 de Octubre University Hospital in Madrid, Spain. METHODS: Patients were identified by analyzing reports of autopsies carried out at the Anatomical Pathology Department of the University Hospital between 1974 and 1977 and between 1980 and 2004. RESULTS: Out of 2041 autopsies, 22 (1.08%) showed evidence of NBTE. The patients' average age was 63.04 years, and neither sex predominated. The underlying disease was an infection in 54.5% of cases, whereas 31.8% had a neoplasm, most frequently a pancreatic adenocarcinoma or renal carcinoma. In 10 cases, there was a previous valvulopathy. The mitral valve was most frequently affected by NBTE (36.5% of cases). In most cases, the cause of death was the underlying disease, though in two patients it was directly related to NBTE (9.1%). In nine cases, an embolism occurred, principally in the spleen, the kidneys or the central nervous system. Before death, there was no suspicion of NBTE in any of these cases. CONCLUSIONS: NBTE is an uncommon disease entity that occurs not only in patients with end-stage neoplastic disease, but also in those with potentially treatable diseases. Consequently, we should raise our level of awareness of this condition so that a diagnosis can be made before the patient dies and anticoagulant treatment can be started, thereby helping to improve prognosis.

Endocarditis trombótica no bacteriana: estudio clínico-patológico de una serie necrópsica / Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series

Introducción y objetivos. La endocarditis trombótica no bacteriana (ETNB) se caracteriza por el depósito de trombos de plaquetas y fibrina estériles sobre válvulas cardiacas. En este estudio se pretende investigar las características clínico-patológicas de los casos de ETNB diagnosticados en el Hospital Universitario 12 de Octubre de Madrid. Métodos. Los casos se recogieron a través del análisis de los informes de las autopsias realizadas en el Departamento de Anatomía Patológica de dicho hospital en 1974-1977 y 1980-2004. Resultados. De 2.041 autopsias, 22 presentaban una ETNB (1,08%). La edad media fue de 63,04 años, sin predominio de sexo. En el 54,5% de los casos la ETNB se asociaba con una infección y en el 31,8% con neoplasias, las más frecuentes de las cuales eran el adenocarcinoma de páncreas y el carcinoma renal. En 10 casos había un daño valvular previo. La localización más frecuente de la ETNB fue la válvula mitral (36,5%). En la mayoría de los casos la muerte se debió a la enfermedad de base, aunque en 2 se relacionó con la ETNB (9,1%). Se detectaron embolias en 9 casos, principalmente en el bazo, el riñón y el sistema nervioso central. En ningún caso se sospechó la ETNB ante mortem. Conclusiones. La ETNB es una entidad poco frecuente que aparece no sólo en pacientes con enfermedades neoplásicas en estadio terminal, sino en pacientes con enfermedades potencialmente curables, por lo que debemos aumentar nuestro grado de sospecha para lograr un diagnóstico en vida e iniciar un tratamiento, la anticoagulación, que podría mejorar el pronóstico (AU)

Introduction and objectives. Nonbacterial thrombotic endocarditis (NBTE) is characterized by sterile platelet and fibrin deposition on cardiac valves. In this study, our aim was to investigate the clinicopathologic characteristics of patients diagnosed with NBTE at the 12 de Octubre University Hospital in Madrid, Spain. Methods. Patients were identified by analyzing reports of autopsies carried out at the Anatomical Pathology Department of the University Hospital between 1974 and 1977 and between 1980 and 2004. Results. Out of 2041 autopsies, 22 (1.08%) showed evidence of NBTE. The patients' average age was 63.04 years, and neither sex predominated. The underlying disease was an infection in 54.5% of cases, whereas 31.8% had a neoplasm, most frequently a pancreatic adenocarcinoma or renal carcinoma. In 10 cases, there was a previous valvulopathy. The mitral valve was most frequently affected by NBTE (36.5% of cases). In most cases, the cause of death was the underlying disease, though in two patients it was directly related to NBTE (9.1%). In nine cases, an embolism occurred, principally in the spleen, the kidneys or the central nervous system. Before death, there was no suspicion of NBTE in any of these cases. Conclusions. NBTE is an uncommon disease entity that occurs not only in patients with end-stage neoplastic disease, but also in those with potentially treatable diseases. Consequently, we should raise our level of awareness of this condition so that a diagnosis can be made before the patient dies and anticoagulant treatment can be started, thereby helping to improve prognosis (AU)