(Circulation. 2000;102:2671.)
© 2000 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Resolution of Nonbacterial Endocarditis After Surgical Resection of a Malignant Liver Tumor
From the Department of Medicine, Cardiology Section (W.M.), Baylor College of Medicine, and the Departments of Cardiology (J.S.), Thoracic and Cardiovascular Surgery (G.L.W.), and Surgical Oncology (M.C., J.N.V.), the University of Texas M.D. Anderson Cancer Center, Houston, Tex.
A 51-year-old
woman presented with significant weight loss and right upper quadrant
abdominal pain. A computed tomography scan of the abdomen showed a
large mass in the right lobe of the liver, with involvement of the
right hemidiaphragm and right lower lobe of the lung
(Figure 1A
). A biopsy revealed poorly differentiated
adenocarcinoma. The patient was referred to M.D. Anderson Cancer Center
for treatment.
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During the hospital stay, the patient had intermittent
high-grade fever, thrombocytopenia, prolonged prothrombin time and
partial thromboplastin time, and elevated D-dimer and fibrinogen
levels; all these symptoms are consistent with paraneoplastic chronic
disseminated intravascular coagulation. Antibiotics were administered
empirically after various cultures, including 3 blood cultures, were
obtained. A transesophageal echocardiogram revealed extensive
vegetations involving both leaflets of the mitral valve
(Figure 2A). Because all cultures were negative, antibiotics
were discontinued and a diagnosis of nonbacterial endocarditis (NBTE)
was made. The patient underwent complete surgical resection of the
tumor (hepatectomy), including en-bloc resection of the right
hemidiaphragm and wedge resection of the lower lobe of the right lung
(Figure 1B
). The fever and hematological abnormalities
resolved promptly after surgery. The postoperative course was
uncomplicated, with hospital discharge on the seventh postoperative
day. A transesophageal echocardiogram performed 4 weeks later revealed
complete resolution of the vegetations
(Figure 2B).
|
In a prospective study of 200 patients with solid tumors, the echocardiographic prevalence of NBTE was 19%, with predominant mitral valve involvement.1 NBTE is typically seen in patients with advanced and incurable malignancy. To our knowledge, this is the first documented case of echocardiographic resolution of NBTE.
Footnotes
Reprint requests to Jean-Nicolas Vauthey, MD, Associate Professor, Chief, Liver Service, Department of Surgical Oncology, the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 106, Houston, TX 77030.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
References
-
Edoute Y,
Haim N, Rinkevich D, et al. Cardiac valvular vegetations in cancer
patients: a prospective echocardiographic study of 200 patients.
Am J Med. 1997;102:252–258.[Medline]
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