Korean Circ J.  2014 May;44(3):189-192. 10.4070/kcj.2014.44.3.189.

Nonbacterial Thrombotic Endocarditis in a Patient with Bowel Infarction due to Mesenteric Vein Thrombosis

• Kim HM
• Kim HL
• Lee HS
• Jung JH
• Kim CH
• Oh S
• Kim JH
• Zo JH

• KMID: 2145481
• DOI: http://doi.org/10.4070/kcj.2014.44.3.189

Abstract

Ante mortem cases of venous thrombosis in patients with nonbacterial thrombotic endocarditis (NBTE) have not yet been reported. We describe a rare case of NBTE in a patient with mesenteric vein thrombosis. A healthy 37-year-old man with abdominal pain and fever underwent emergency small bowel resection due to bowel ischemia resulting from mesenteric vein thrombosis. Transthoracic echocardiography revealed multiple mobile masses attached to the anterior leaflet of the mitral valves and their chordae tendineae. On suspicion of infective endocarditis, the cardiac masses were excised through open-heart surgery. However, pathologic reviews were compatible with NBTE. The patient was stable after the cardiac surgery and was treated with warfarin. Laboratory and imaging findings regarding his hypercoagulable condition were all negative.

Keyword

Endocarditis, non-infective; Echocardiography; Venous thrombosis

MeSH Terms

Abdominal Pain
Adult
Ants
Chordae Tendineae
Echocardiography
Emergencies
Endocarditis*
Endocarditis, Non-Infective
Fever
Humans
Infarction*
Ischemia
Mesenteric Veins*
Mitral Valve
Thoracic Surgery
Thrombosis*
Venous Thrombosis
Warfarin
Warfarin

Figure

• 

  Fig. 1 Computed tomographic scan of the abdomen demonstrating small bowel ischemia associated with mesenteric venous thrombosis. Thrombosis at the superior mesenteric and splenic veins (blue arrows) with an intact superior mesenteric artery (red arrow) (A and B), thrombosis at the portal vein (blue arrow) (C) and edematous proximal jejunum with ischemic changes (white arrows) (D).

• 

  Fig. 2 Transthoracic echocardiography illustrating cardiac masses (red arrows). RV: right ventricle, LV: left ventricle, Ao: aorta, LA: left atrium.

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  Fig. 3 Gross pathology of excised cardiac masses.

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  Fig. 4 Pathology of cardiac masses composed of necrotic fibrin thrombus without evidence of inflammation or bacteria favoring the diagnosis of nonbacterial thrombotic endocarditis. Hematoxylin-eosin stain, 100× magnification (A) and 200× magnification (B).

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