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Case Reports
. 2025 Oct 13;17(10):e94472.
doi: 10.7759/cureus.94472. eCollection 2025 Oct.

Nonbacterial Thrombotic Endocarditis of the Aortic Valve Secondary to Urothelial Carcinoma With Pancreatic Metastases

Alex P Rodriguez  1 , Sonia I Vicenty-Rivera  1   2
Affiliations
Case Reports

Nonbacterial Thrombotic Endocarditis of the Aortic Valve Secondary to Urothelial Carcinoma With Pancreatic Metastases

Alex P Rodriguez et al. Cureus. .

Abstract

A 72-year-old male with a medical history significant for ischemic cardiomyopathy, prostate cancer, and peripheral vascular disease presented with jaundice, progressive frailty, and anemia. Transthoracic echocardiography identified a new aortic valve vegetation. Comprehensive infectious evaluation yielded negative results, and cardiac magnetic resonance (CMR) imaging demonstrated a non-enhancing lesion involving the aortic valve. Given the negative infectious evaluation and absence of systemic signs of infection, a diagnosis of nonbacterial thrombotic endocarditis (NBTE) was favored. Concurrent imaging revealed pancreatic involvement by metastatic urothelial carcinoma. Anticoagulation therapy was initiated but subsequently discontinued due to the development of symptomatic anemia and thrombocytopenia. This case underscores the diagnostic utility of CMR in characterizing valvular lesions and emphasizes the importance of malignancy screening in patients with suspected NBTE. A multidisciplinary approach enabled the formulation of a patient-centered management strategy within the context of advanced malignancy.

Keywords: aortic valve; cardiac magnetic resonance; cardiac metastasis; nonbacterial endocarditis; transthoracic echocardiography; urothelial carcinoma.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Two-dimensional transthoracic echocardiography (Panel A: parasternal long-axis view, Panel B: parasternal short-axis view, Panel C: apical three-chamber view, and Panel D: apical five-chamber view) demonstrates a trileaflet aortic valve with leaflet thickening but preserved systolic excursion. Notably, a sclerotic, prolapsing structure is visualized between the right and left coronary cusps, raising suspicion for valvular vegetation (yellow arrow).
LA: left atrium RA: right atrium LV: left ventricle MVAL: mitral valve anterior leaflet MVPL: mitral valve posterior leaflet LVOT: left ventricular outflow tract
Figure 2
Figure 2. Cardiac MRI three-chamber views (Panels A and B) demonstrate an aortic valve with leaflet thickening and a vegetation adherent to one of the aortic cusps (yellow arrow).
LA: left atrium RA: right atrium LV: left ventricle RV: right ventricle AV: aortic valve Asc Ao: ascending aorta
Figure 3
Figure 3. Cardiac magnetic resonance (CMR) three-chamber view (left panel) demonstrates thickened aortic valve cusps with associated aortic regurgitant flow originating from the right coronary cusp and extending into the left ventricular outflow tract (LVOT) (yellow arrow), accompanied by evidence of aortic regurgitation (green arrow). The right panel displays flow sequences, which reveal no significant aortic regurgitation.
LV: left ventricle LA: left atrium AoV: aortic valve Asc Ao: ascending aorta Desc Ao: descending aorta
Figure 4
Figure 4. Cardiac magnetic resonance (CMR) assessment of the aortic valve and annulus on orthogonal valve-planned cine images without evidence of perivalvular abscess, valvular perforation, or rupture (yellow dashed circle).
PV: pulmonary veins AoV: aortic valve LA: left atrium RA: right atrium LV: left ventricle RV: right ventricle
Figure 5
Figure 5. Management of Cancer Related Nonbacterial Endocarditis
MI: myocardial infarction TEE: transesophageal echocardiography LMWH: low molecular weight heparin UFH: unfractionated heparin DOAC: direct oral anticoagulant
See this image and copyright information in PMC

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