Nguyen Hoa Thi Thuy, Nguyen Yen Thi Hai, Kirkpatrick James N, Nguyen Viet Khoi, Nguyen Anh Van, Pham Hung Manh, Taylor Walter Robert, Nguyen Hoai Thi Thu
Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam.
Department of Internal Medicine, VNU-University of Medicine and Pharmacy, Hanoi, Vietnam.
Cancer Rep (Hoboken). 2024 Dec;7(12):e70088. doi: 10.1002/cnr2.70088.
Nonbacterial thrombotic endocarditis (NBTE) is a rare cardiac manifestation in patients with advanced malignancies of the lungs, pancreas, gynecological system, and gastrointestinal tract. It is often confirmed postmortem by histopathological evidence of sterile platelet-fibrin deposits attached to the endocardium, most often on heart valves. To the best of our knowledge, our case is the first to report multiple heart lesions caused by the systemic effect of cholangiocarcinoma.
We report the case of a 53-year-old male who presented with a stroke; extensive imaging studies, including transthoracic echocardiography (TTE), 2D/3D transesophageal echocardiography (TEE), cardiac multi-slice computed tomography, and cardiac magnetic resonance, found masses on the mitral valve, the aortic valve, and in the right ventricle, with the largest diameter 43 × 11 mm, which led to a diagnosis of NBTE secondary to presumed cholangiocarcinoma. Combining different echocardiography techniques, including TTE and TEE in specific clinical contexts, and training echocardiographers to improve TEE interpretation skills could be the most cost-effective option for early diagnosis, particularly in limited-resource settings, where advanced imaging modalities are not widely applicable.
NBTE can manifest in patients with advanced cancer. A high index of clinical suspicion is of central importance for the diagnosis of NBTE, especially through an identification of the underlying predisposing conditions. A multi-disciplinary approach is crucial for NBTE optimal diagnosis and treatment. As in our patient, multimodality imaging plays a complementary role in clearly defining the nature of cardiac lesions.
非细菌性血栓性心内膜炎（NBTE）是肺部、胰腺、妇科系统和胃肠道晚期恶性肿瘤患者中一种罕见的心脏表现。通常在尸检时通过附着于心内膜（最常见于心脏瓣膜）的无菌血小板 - 纤维蛋白沉积物的组织病理学证据得以确诊。据我们所知，我们的病例是首例报告由胆管癌的全身效应引起的多个心脏病变。
我们报告了一名53岁男性中风患者的病例；广泛的影像学检查，包括经胸超声心动图（TTE）、二维/三维经食管超声心动图（TEE）、心脏多层计算机断层扫描和心脏磁共振成像，发现二尖瓣、主动脉瓣及右心室有肿块，最大直径为43×11毫米，由此诊断为推测胆管癌继发的NBTE。在特定临床情况下结合不同的超声心动图技术，包括TTE和TEE，并培训超声心动图医生以提高TEE解读技能，可能是早期诊断最具成本效益的选择，特别是在资源有限的环境中，那里先进的成像方式并不广泛适用。
NBTE可在晚期癌症患者中表现出来。高度的临床怀疑指数对NBTE的诊断至关重要，特别是通过识别潜在的易感因素。多学科方法对于NBTE的最佳诊断和治疗至关重要。正如我们的患者一样，多模态成像在明确心脏病变的性质方面发挥着互补作用。
