title: Nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage: case report.
abstract: A 63-year-old man was admitted to our hospital with a complaint of right lateroabdominal pain. He was diagnosed with metastatic colon cancer, and then developed multiple brain embolic infarctions 7 days after admission. Transesophageal echocardiography showed that mobile, echo-dense masses were attached to the anterior and posterior mitral valve leaflet. Furthermore, there was a thrombus in the left auricular appendage despite sinus rhythm. These findings led to a diagnosis of suspected infectious endocarditis with subsequent multiple brain infarctions. The patient's general condition worsened and he died 13 days after admission. An autopsy was performed, and, while poorly differentiated cancer was observed in multiple organs, no primary tumor could be identified. Histological analysis showed that the masses of the mitral valve consisted mainly of fibrin without bacteria or oncocytes. This patient was therefore diagnosed with nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Norisada
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Tetsuari
authors.initials: T
authors.lastname: Onishi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kaneko
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tsuji
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamawaki
authors.forename: Keiko
authors.initials: K
authors.lastname: Ryo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Natsuko
authors.initials: N
authors.lastname: Miura
authors.forename: Jun
authors.initials: J
authors.lastname: Saegusa
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Morinaga
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hara
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kawai
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D001424:Bacterial Infections / Q000150:complications / Q000000981:diagnostic imaging; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000150:complications* / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging*; D014463:Ultrasonography