Norisada Kazuko, Tanaka Hidekazu, Onishi Tetsuari, Kaneko Akihiro, Tsuji Takayuki, Yamawaki Kohei, Ryo Keiko, Tatsumi Kazuhiro, Matsumoto Kensuke, Miura Natsuko, Saegusa Jun, Morinaga Yukiko, Hara Shigeo, Kawai Hiroya, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Cardiovasc Ultrasound. 2011 Feb 28;9:8. doi: 10.1186/1476-7120-9-8.
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.
一名63岁男性因右侧腹外侧疼痛入院。他被诊断为转移性结肠癌，入院7天后发生多发性脑栓塞性梗死。经食管超声心动图显示，活动的、回声密集的团块附着于二尖瓣前后叶。此外，尽管为窦性心律，但左心耳内有血栓。这些发现导致诊断为疑似感染性心内膜炎并继发多发性脑梗死。患者的一般状况恶化，入院13天后死亡。进行了尸检，虽然在多个器官中观察到低分化癌，但未发现原发性肿瘤。组织学分析显示，二尖瓣团块主要由纤维蛋白组成，无细菌或肿瘤细胞。因此，该患者被诊断为与不明来源癌症相关的非细菌性血栓性心内膜炎，并伴有左心耳血栓形成。
