title: Nonbacterial thrombotic endocarditis with recurrent embolic events as manifestation of ovarian neoplasm.
abstract: We describe the case of a 43-year-old woman with transient ischemic neurologic deficits and recurrent systemic and pulmonary emboli in whom infectious work-up and extensive thrombophilic evaluation were unremarkable. Transesophageal echocardiography (TEE) established the diagnosis of nonbacterial thrombotic endocarditis (NBTE). This is a rare condition often associated with hypercoagulable states or advanced malignancy such as adenocarcinomas, characterized by cardiac vegetations along valvular coaptation lines without destruction of leaflets. In our patient, we diagnosed an ovarian clear cell adenocarcinoma, a malignant disorder that has been rarely reported in association with NBTE. This case illustrates that NBTE can present as an atypical manifestation of malignancy and must be distinguished from infective endocarditis, which implies a different therapeutic strategy. When confronted with findings of NBTE without a clear etiology, an occult neoplasm must be excluded. Anticoagulant therapy is the mainstay of treatment. However, cardiac vegetations may require surgical intervention in rare instances.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02114, USA. aaryana@partners.org
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Esterbrooks
authors.forename: Peter C
authors.initials: PC
authors.lastname: Morris
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000150:complications* / Q000000981:diagnostic imaging; D000328:Adult; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000175:diagnosis; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000209:etiology*; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*