Cargando…

Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report

BACKGROUND: Non-bacterial thrombotic endocarditis is a rare condition. Optimal management is based on early diagnosis which remains difficult. CASE SUMMARY: A 75-year-old male patient was admitted to the hospital with acute ischaemia of the left lower limb due to popliteal artery occlusion despite a...

Descripción completa

Detalles Bibliográficos
Autores principales: Polo, Julien, Raufast, Daniele, Cornand, Dimitri, Elias, Antoine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634418/
https://www.ncbi.nlm.nih.gov/pubmed/34859183
http://dx.doi.org/10.1093/ehjcr/ytab426
_version_ 1784608124808724480
author Polo, Julien
Raufast, Daniele
Cornand, Dimitri
Elias, Antoine
author_facet Polo, Julien
Raufast, Daniele
Cornand, Dimitri
Elias, Antoine
author_sort Polo, Julien
collection PubMed
description BACKGROUND: Non-bacterial thrombotic endocarditis is a rare condition. Optimal management is based on early diagnosis which remains difficult. CASE SUMMARY: A 75-year-old male patient was admitted to the hospital with acute ischaemia of the left lower limb due to popliteal artery occlusion despite anticoagulation with rivaroxaban for pulmonary embolism diagnosed 2 weeks earlier. Transoesophageal echocardiography (TOE) showed a mobile vegetation with mild mitral valve regurgitation. Positron emission tomography (PET) scan did not show hyperfixation at the mitral valve but rather lymphadenopathy hyperfixation at different sites. Biopsy of a lymph node from Barety’s space identified a bronchopulmonary adenocarcinoma. The outcome was favourable after popliteal artery thrombectomy and low-molecular-weight heparin treatment. The patient was referred to the department of onco-pneumology for further care. DISCUSSION: Upon clinical presentation, the combination of an arterial and prior venous thrombotic event suggested that the origin could be either a patent foramen ovale (PFO) or a thrombosis from an underlying cancer. A transthoracic echocardiography and TOE excluded a PFO and demonstrated a mobile echogenic mass at the mitral valve site together with a mild regurgitation. The diagnosis of non-bacterial thrombotic endocarditis was suggested given the absence of clinical and biological infectious signs, negative blood cultures and serology for endocarditis, the presence of both arterial and venous thrombosis, as well as the presence of intra-thoracic lymphadenopathy hyperfixation on the PET scan for which a biopsy demonstrated lung adenocarcinoma.
format Online
Article
Text
id pubmed-8634418
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-86344182021-12-01 Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report Polo, Julien Raufast, Daniele Cornand, Dimitri Elias, Antoine Eur Heart J Case Rep Case Report BACKGROUND: Non-bacterial thrombotic endocarditis is a rare condition. Optimal management is based on early diagnosis which remains difficult. CASE SUMMARY: A 75-year-old male patient was admitted to the hospital with acute ischaemia of the left lower limb due to popliteal artery occlusion despite anticoagulation with rivaroxaban for pulmonary embolism diagnosed 2 weeks earlier. Transoesophageal echocardiography (TOE) showed a mobile vegetation with mild mitral valve regurgitation. Positron emission tomography (PET) scan did not show hyperfixation at the mitral valve but rather lymphadenopathy hyperfixation at different sites. Biopsy of a lymph node from Barety’s space identified a bronchopulmonary adenocarcinoma. The outcome was favourable after popliteal artery thrombectomy and low-molecular-weight heparin treatment. The patient was referred to the department of onco-pneumology for further care. DISCUSSION: Upon clinical presentation, the combination of an arterial and prior venous thrombotic event suggested that the origin could be either a patent foramen ovale (PFO) or a thrombosis from an underlying cancer. A transthoracic echocardiography and TOE excluded a PFO and demonstrated a mobile echogenic mass at the mitral valve site together with a mild regurgitation. The diagnosis of non-bacterial thrombotic endocarditis was suggested given the absence of clinical and biological infectious signs, negative blood cultures and serology for endocarditis, the presence of both arterial and venous thrombosis, as well as the presence of intra-thoracic lymphadenopathy hyperfixation on the PET scan for which a biopsy demonstrated lung adenocarcinoma. Oxford University Press 2021-10-28 /pmc/articles/PMC8634418/ /pubmed/34859183 http://dx.doi.org/10.1093/ehjcr/ytab426 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Polo, Julien
Raufast, Daniele
Cornand, Dimitri
Elias, Antoine
Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
title Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
title_full Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
title_fullStr Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
title_full_unstemmed Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
title_short Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
title_sort acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634418/
https://www.ncbi.nlm.nih.gov/pubmed/34859183
http://dx.doi.org/10.1093/ehjcr/ytab426
work_keys_str_mv AT polojulien acuteischaemiaofthelowerlimbduetononbacterialthromboticendocarditiswithrecentvenousthromboembolicdiseaseastheinitialmanifestationoflungadenocarcinomaacasereport
AT raufastdaniele acuteischaemiaofthelowerlimbduetononbacterialthromboticendocarditiswithrecentvenousthromboembolicdiseaseastheinitialmanifestationoflungadenocarcinomaacasereport
AT cornanddimitri acuteischaemiaofthelowerlimbduetononbacterialthromboticendocarditiswithrecentvenousthromboembolicdiseaseastheinitialmanifestationoflungadenocarcinomaacasereport
AT eliasantoine acuteischaemiaofthelowerlimbduetononbacterialthromboticendocarditiswithrecentvenousthromboembolicdiseaseastheinitialmanifestationoflungadenocarcinomaacasereport