Nonbacterial thrombotic endocarditis with recurrent embolic events as manifestation of ovarian neoplasm

J Gen Intern Med. 2006 Dec;21(12):C12-5. doi: 10.1111/j.1525-1497.2006.00614.x. Epub 2006 Sep 11.


We describe the case of a 43-year-old woman with transient ischemic neurologic deficits and recurrent systemic and pulmonary emboli in whom infectious work-up and extensive thrombophilic evaluation were unremarkable. Transesophageal echocardiography (TEE) established the diagnosis of nonbacterial thrombotic endocarditis (NBTE). This is a rare condition often associated with hypercoagulable states or advanced malignancy such as adenocarcinomas, characterized by cardiac vegetations along valvular coaptation lines without destruction of leaflets. In our patient, we diagnosed an ovarian clear cell adenocarcinoma, a malignant disorder that has been rarely reported in association with NBTE. This case illustrates that NBTE can present as an atypical manifestation of malignancy and must be distinguished from infective endocarditis, which implies a different therapeutic strategy. When confronted with findings of NBTE without a clear etiology, an occult neoplasm must be excluded. Anticoagulant therapy is the mainstay of treatment. However, cardiac vegetations may require surgical intervention in rare instances.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma, Clear Cell / complications*
  • Adenocarcinoma, Clear Cell / diagnostic imaging
  • Adult
  • Diagnosis, Differential
  • Echocardiography, Transesophageal
  • Endocarditis / diagnosis
  • Endocarditis / diagnostic imaging
  • Endocarditis / etiology*
  • Endocarditis, Bacterial / diagnosis
  • Female
  • Humans
  • Ovarian Neoplasms / complications*
  • Ovarian Neoplasms / diagnostic imaging
  • Pulmonary Embolism / etiology*
  • Recurrence
  • Tomography, X-Ray Computed
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / etiology*