RT Journal Article
SR Electronic
T1 Marantic endocarditis: incidental infarcts leading to diagnosis of pancreatic cancer
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2018-224529
DO 10.1136/bcr-2018-224529
VO 2018
A1 Ella Starobinska
A1 Eric A Robinson
A1 Eric Brucks
A1 Serena Scott
YR 2018
UL http://casereports.bmj.com/content/2018/bcr-2018-224529.abstract
AB Non-bacterial thrombotic endocarditis (NBTE) is a well-described phenomenon associated with malignancies due to hypercoaguable state. In the setting of pancreatic cancer, NBTE is more commonly diagnosed postmortem. We describe a case of a man who was diagnosed with pancreatic carcinoma after incidental finding of NBTE. Imaging incidentally revealed multiple strokes, bilateral renal and splenic infarcts, while subsequent workup for cardioembolic source demonstrated a 1.1×0.7 cm mitral valve vegetation. As multiple blood cultures were sterile and patient lacked clinical signs of infection, an underlying malignancy was suspected. CT abdomen demonstrated a dilated pancreatic duct, MRI showed a 2.8×2.2 cm pancreatic head mass. Endoscopic biopsy of the mass revealed pancreatic adenocarcinoma. Other than NBTE, there were no other clinical or laboratory findings to clearly suggest pancreatic cancer. Thus, incidental discovery of this mitral valve vegetation led to the diagnosis of pancreatic malignancy.