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Non-bacterial thrombotic endocarditis and coronary thrombectomy in a patient with metastatic small cell lung carcinoma
  1. Kelsey Margaret Gray1,
  2. Bao Nguyen2,
  3. Larissa Baker1 and
  4. Masood Ahmad2
  1. 1School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  2. 2Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  1. Correspondence to Kelsey Margaret Gray; kmgray{at}utmb.edu

Abstract

A 66-year-old Caucasian man was initially admitted with a metastatic small cell lung carcinoma, hyponatraemia and obstructive pneumonia. His transthoracic echocardiogram (TTE) was normal. Ten days after admission, he was diagnosed with a non-ST segment elevation myocardial infarction (MI). Both a repeated TTE and a transoesophageal echocardiogram identified thickened, myxomatous mitral valve leaflet tips with small, mobile masses identified as vegetations, and new, eccentric, severe mitral regurgitation. Subsequent cardiac catheterisation recorded thrombotic occlusion of the right coronary artery. Successful coronary thrombectomy was carried out, but the patient died. A diagnosis of non-bacterial thrombotic endocarditis leading to coronary embolisation and MI was made. The clinical course and treatment choices are discussed.

  • cardiovascular medicine
  • cancer - see oncology
  • interventional cardiology
  • valvar diseases
  • cardiovascular system

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Footnotes

  • Contributors MA and BN oversaw all patient care, while KMG and LB help tend to the patient in the hospital setting. MA conceptualised the case report. BN and KMG reviewed the patient chart for details included in the case report. KMG was responsible for the original draft of the manuscript, acquisition and interpretation of data. MA and BN were responsible for interpretation of data and revision of both intellectual content and writing style. LB helped with writing and revision of the manuscript. MA captured images from echocardiograms and created figures with corresponding descriptions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.