Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report
ABSTRACT Introduction 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...
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2024-12-01
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| Online Access: | https://doi.org/10.1002/cnr2.70088 |
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| author | Hoa Thi Thuy Nguyen Yen Thi Hai Nguyen James N. Kirkpatrick Viet Khoi Nguyen Anh Van Nguyen Hung Manh Pham Walter Robert Taylor Hoai Thi Thu Nguyen |
| author_facet | Hoa Thi Thuy Nguyen Yen Thi Hai Nguyen James N. Kirkpatrick Viet Khoi Nguyen Anh Van Nguyen Hung Manh Pham Walter Robert Taylor Hoai Thi Thu Nguyen |
| author_sort | Hoa Thi Thuy Nguyen |
| collection | DOAJ |
| description | ABSTRACT Introduction 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. Case Presentation 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. Conclusions 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. |
| format | Article |
| id | doaj-art-922bfae74fef4fdb881101dad4a8d0c3 |
| institution | DOAJ |
| issn | 2573-8348 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Reports |
| spelling | doaj-art-922bfae74fef4fdb881101dad4a8d0c32025-08-20T02:51:14ZengWileyCancer Reports2573-83482024-12-01712n/an/a10.1002/cnr2.70088Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case ReportHoa Thi Thuy Nguyen0Yen Thi Hai Nguyen1James N. Kirkpatrick2Viet Khoi Nguyen3Anh Van Nguyen4Hung Manh Pham5Walter Robert Taylor6Hoai Thi Thu Nguyen7Vietnam National Heart Institute Bach Mai Hospital Hanoi VietnamVietnam National Heart Institute Bach Mai Hospital Hanoi VietnamCardiovascular Division, Department of Medicine, Department of Bioethics and Humanities University of Washington Medical Center Seattle Washington USARadiology Center Bach Mai Hospital Hanoi VietnamVietnam National Heart Institute Bach Mai Hospital Hanoi VietnamVietnam National Heart Institute Bach Mai Hospital Hanoi VietnamMahidol Oxford Tropical Medicine Research Unit Bangkok ThailandVietnam National Heart Institute Bach Mai Hospital Hanoi VietnamABSTRACT Introduction 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. Case Presentation 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. Conclusions 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.https://doi.org/10.1002/cnr2.70088cardiac magnetic resonance imagingcase reportliver adenocarcinomamultimodality imagingnonbacterial thrombotic endocarditisthree‐dimensional transesophageal echocardiography |
| spellingShingle | Hoa Thi Thuy Nguyen Yen Thi Hai Nguyen James N. Kirkpatrick Viet Khoi Nguyen Anh Van Nguyen Hung Manh Pham Walter Robert Taylor Hoai Thi Thu Nguyen Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report Cancer Reports cardiac magnetic resonance imaging case report liver adenocarcinoma multimodality imaging nonbacterial thrombotic endocarditis three‐dimensional transesophageal echocardiography |
| title | Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report |
| title_full | Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report |
| title_fullStr | Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report |
| title_full_unstemmed | Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report |
| title_short | Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report |
| title_sort | multimodality imaging supports cardiac lesion diagnosis in patient with liver carcinoma a case report |
| topic | cardiac magnetic resonance imaging case report liver adenocarcinoma multimodality imaging nonbacterial thrombotic endocarditis three‐dimensional transesophageal echocardiography |
| url | https://doi.org/10.1002/cnr2.70088 |
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