A Transesophageal Echocardiogram Finding: From Infection to Malignancy

Area of Science:

• Cardiology
• Pathology
• Oncology

Background:

• Nonbacterial thrombotic endocarditis (NBTE) is characterized by thrombi on heart valves without bacteremia, often associated with chronic illnesses like cancer or autoimmune diseases.
• Pathogenesis involves endothelial injury and hypercoagulable states driven by circulating cytokines, leading to platelet deposition.
• NBTE typically affects individuals aged 40-80, with vegetations forming on specific valve surfaces and distinct morphology compared to infective endocarditis.

Observation:

• Cerebrovascular lesions in NBTE present as multiple, widespread small and large strokes on MRI.
• A case study highlights a 78-year-old male initially diagnosed with pneumonia and infective endocarditis (IE).
• Trans-esophageal echocardiogram (TEE) revealed Libman-Sacks findings, leading to a revised diagnosis of lung cancer.

Findings:

• Trans-esophageal echocardiogram (TEE) is crucial for identifying characteristic NBTE vegetations.
• Libman-Sacks findings on TEE can be indicative of NBTE.
• The distinct TEE appearance of NBTE aids in differentiating it from infective endocarditis.

Implications:

• Recognizing characteristic TEE findings of NBTE is vital for clinicians.
• Prompt diagnosis of NBTE can facilitate the search for underlying causes, particularly malignancies.
• Early identification of NBTE-associated cancers can improve patient outcomes through timely intervention.