Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography.

Area of Science:

• Cardiology
• Oncology
• Pathology

Background:

• Nonbacterial thrombotic endocarditis (NBTE) is a rare condition often associated with malignancy.
• Cerebral infarctions can be a presenting symptom of NBTE, posing diagnostic challenges.

Purpose of the Study:

• To report a case of NBTE in a patient with advanced bladder cancer.
• To highlight the diagnostic challenges and the importance of repeat imaging in suspected NBTE.

Main Methods:

• Transthoracic and transesophageal echocardiography were performed initially and upon recurrence of embolic events.
• Abdominal ultrasound and CT scans were used to evaluate for metastatic disease.
• Blood cultures were utilized to rule out infective endocarditis.

Main Results:

• Initial echocardiography was negative, but repeat imaging revealed mitral valve vegetation consistent with NBTE.
• The patient had multiple metastatic bladder cancer masses and negative blood cultures.
• The final diagnosis was NBTE secondary to bladder cancer metastases.

Conclusions:

• NBTE should be suspected in cancer patients presenting with thromboembolic events, even with initial negative echocardiograms.
• Recurrent embolic events warrant repeat echocardiographic evaluation for NBTE.
• Early recognition and diagnosis of NBTE in cancer patients are critical for appropriate management.