Cholangiocarcinoma Manifesting as Non-Bacterial Thrombotic Endocarditis in a Young Patient

Nadkarni, Ninad; Lee, Young Ju; Hoefen, Ryan; Alweis, Richard

doi:10.1016/j.amjmed.2019.11.033

Cited by 3 publications

(4 citation statements)

References 15 publications

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“… 9 – 13 Among the few previously reported cases, only three cases had confirmed NBTE with echocardiography finding of valve mass or vegetations, the present case is the youngest case. 9 , 13 , 14 Cholangiocarcinoma associated with NBTE has poor prognosis and most of the reported cases were advance at diagnosis or were diagnosed on autopsy. 9 The definitive diagnosis can be made pathologically by the demonstration of platelet thrombi on autopsy or surgical specimens.…”

Section: Discussionmentioning

confidence: 66%

“…8 Since then very few cases, with a total of only 11 cases including an autopsy case, had been reported. 9–13 Among the few previously reported cases, only three cases had confirmed NBTE with echocardiography finding of valve mass or vegetations, the present case is the youngest case. 9,13,14 Cholangiocarcinoma associated with NBTE has poor prognosis and most of the reported cases were advance at diagnosis or were diagnosed on autopsy.…”

Section: Discussionmentioning

confidence: 66%

“… 2 , 3 , 16 Although experience is more limited, low molecular weight heparin has also been useful. 2 , 3 , 13 , 16 Vitamin K antagonists such as warfarin are not suggested in malignancy-associated NBTE, due to the risk of recurrent thromboembolic events. 2 , 3 , 16 The novel oral anticoagulants (NOACs) are currently considered an attractive option but remains unknown whether it will be effective.…”

Section: Discussionmentioning

confidence: 99%

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Nonbacterial thrombotic endocarditis as an initial presentation of advanced cholangiocarcinoma in a young patient: A case report

Al‐Ghamdi

Alkaf

Alanazi

et al. 2020

SAGE Open Medical Case Reports

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Nonbacterial thrombotic endocarditis, a form of noninfectious thrombotic endocarditis, is mainly characterized by deposition of sterile platelet thrombi on heart valves. Usually, it is observed in advanced malignancy. Herein, we report a case of a previously healthy male with recent unprovoked deep vein thrombosis presented with acute ischemic stroke. The echocardiogram revealed aortic and mitral valve masses. Eventually, he was discovered to have advanced cholangiocarcinoma. The present case, apart from being the youngest reported case, is among the few reported cases which manifest the association between cholangiocarcinoma and nonbacterial thrombotic endocarditis.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Nonbacterial thrombotic endocarditis as an initial presentation of advanced cholangiocarcinoma in a young patient: A case report

Al‐Ghamdi

Alkaf

Alanazi

et al. 2020

SAGE Open Medical Case Reports

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“…The flow chart of our included studies is shown in Supplementary Figure S1 . Around 25% (39) of included studies were from the USA, and only 1 study was reported from China [ 19 , 22 , 23 , 24 , 27 , 29 , 32 , 33 , 34 , 39 , 41 , 43 , 46 , 47 , 48 , 57 , 58 , 59 , 68 , 69 , 73 , 76 , 81 , 84 , 86 , 88 , 92 , 93 , 94 , 100 , 101 , 105 , 108 , 111 , 114 , 115 , 118 , 131 , 132 , 136 ]. A list of the included studies and the quality assessment are reported in Supplementary Table S2 .…”

Section: Resultsmentioning

confidence: 99%

Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients’ Data

Rahouma

Khairallah

Dabsha

et al. 2023

Cancers

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Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21–0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13–0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61–0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56–0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with 6-month OS of 20.8% vs. 37.0% in lung vs. other cancers, respectively (p = 0.06) and 42.9% vs. 31.1% among those who underwent intervention vs. those who did not (p = 0.07). Cases discovered in recent years had better survival (HR = 0.98 (95% CI, 0.96–0.99; p = 0.003). While cancer-associated NBTE is a rare entity, lung cancers were the most common tumor site and are frequently associated with more advanced and metastatic cancer stages. The prognosis is dismal, especially among lung cancers.

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Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report

Nguyen,

Kirkpatrick

et al. 2024

Cancer Reports

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IntroductionNonbacterial 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.Case PresentationWe 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.ConclusionsNBTE 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.

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Cholangiocarcinoma Manifesting as Non-Bacterial Thrombotic Endocarditis in a Young Patient

Cited by 3 publications

References 15 publications

Nonbacterial thrombotic endocarditis as an initial presentation of advanced cholangiocarcinoma in a young patient: A case report

Nonbacterial thrombotic endocarditis as an initial presentation of advanced cholangiocarcinoma in a young patient: A case report

Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients’ Data

Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report

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