Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 73-year-old man with history of coronary artery disease and bypass surgery, atrial fibrillation, and left lower lobe non-small cell lung cancer was admitted with recurrent pneumonia and was referred for transesophageal echocardiogram for suspected aortic valve endocarditis by transthoracic echocardiography. The patient had a history of radiation treatment for lung cancer 6 years ago. He had subsequently developed esophageal strictures requiring repeated dilatations, and eventually repeated esophageal stenting. Recurrent aspiration pneumonia led to the discovery of stent erosion into his trachea leading to tracheoesophageal fistula. A covered Y tracheal stent was placed to close the fistulous tract, but persistent aspiration was noted. The cross-sectional diameter of the esophageal stents was determined to be larger than the transesophageal echocardiography (TEE) probe. TEE was performed under fluoroscopy for added safety. The esophageal stent position was confirmed with fluoroscopy before and after the procedure and the TEE probe remained inside the distal stent in the midesophageal position during the entire procedure. Small mobile vegetation was seen on the right coronary cusp and the noncoronary cusp showed a smaller vegetation. The patient tolerated the procedure well and there were no complications. Infectious disease consultation was obtained and antibiotic regimen was modified accordingly. Although there are studies addressing the safety of TEE in patients with esophageal varices, to our knowledge, there is no report of TEE being performed in patients with esophageal or tracheoesophageal stents. This case illustrates that TEE may be performed in patients with esophageal stents under careful fluoroscopic guidance. (Echocardiography 2012;29:E5-E7).
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PMID:Fluoroscopically guided transesophageal echocardiogram in a patient with esophageal stents. 2198 95

Thromboembolic events are frequent in patients with cancer, commonly involving the venous and pulmonary circulation. The arterial system is rarely implicated in embolism and, when involved, a cardiogenic origin should always be excluded. In the present study, a case of a patient who developed multiple embolic events concomitantly with the diagnosis of locally-advanced non-small cell lung cancer with high expression levels of programmed death-ligand 1 (PD-L1) in >50% of tumor cells is reported. A cardiac defect interpreted as a patent foramen ovale required low molecular weight heparin administration. Despite the anti-coagulant therapy, before first-line anticancer treatment with pembrolizumab immunotherapy could be administered due to high PD-L1 expression levels, a new hospitalization was required due to the onset of novel ischemic manifestation. New transthoracic and transesophageal echocardiography revealed a previously misdiagnosed vegetation of the mitral valve that caused systemic embolization. The lack of any sign of infection led to the diagnosis of a non-bacterial thrombotic endocarditis (NBTE), whose embolic sprouting gave rise to the widespread ischemic events. No active anticancer treatment was feasible due to the rapid progression of the disease. NBTE can evolve quickly, eventually preventing any chance of treatment targeting the primary cause, which in the present study was lung cancer. If NBTE can be correctly diagnosed sooner then there may be the potential for anticancer therapy that does not worsen the hypercoagulability state, thus improving cancer-associated survival.
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PMID:Systemic thromboembolism from a misdiagnosed non-bacterial thrombotic endocarditis in a patient with lung cancer: A case report. 3295 63