Non-Infective Thrombotic Endocarditis

Clinical History

This patient presented with a story of progressive dyspnoea over 3 weeks. This was associated with lassitude and ankle swelling. Examination revealed a large pleural effusion on the right-hand side. The apex beat was in the left 7th intercostal space, 17.5 cm from the mid-sternal line. There was a dual rhythm and no bruits were present. Five litres of fluid were removed from the pleural cavity at paracentesis. Bronchoscopy showed a distortion of the carina and collapse of the right bronchial tree. No mucosal abnormality was seen. Death was sudden following the development of fine crepitations on the left-hand side of the chest.

Pathology

The specimen is of right atrium and ventricle laid open to display the tricuspid valve. Two thrombi, 8 mm and 3 mm in diameter, are adherent to the chordae of the valve. There appears to be no valvular destruction. Microscopically, these vegetations consisted of masses of platelets and fibrin and only a few scattered organisms. At necropsy, a necrotic cystic adenocarcinoma was found in the right lung with left femoral vein thrombosis and thrombus in the left pulmonary artery.