Nonbacterial Thrombotic Endocarditis Vanished Completely With Heparin Administration and Resection of Ovarian Cancer
症例は54歳女性．20XX年4月，左半側空間無視と左片麻痺を主訴に前医へ救急搬送された．入院後の造影CTとMRI/MRA検査で右内頸動脈起始部閉塞による脳梗塞と深部静脈血栓症（DVT），粘液性卵巣癌を認めた．経胸壁心エコー（TTE）と経食道心エコー（TEE）では心腔内血栓を指摘できなかったが，心原性脳梗塞・奇異性脳塞栓の可能性が否定できず，直接経口抗凝固薬（DOAC）内服が開始された．この際に指摘された卵巣癌に対して7月，当院で卵巣摘出術を施行した．血栓イベント高リスクであるため，術中TEEを施行し，僧帽弁前尖および後尖に10 mm程度の可動性を有する構造物を認めた．形態より感染性心内膜炎を疑...
Saved in:
| Published in | Shinzo Vol. 53; no. 9; pp. 998 - 1004 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
15.09.2021
公益財団法人 日本心臓財団 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.53.998 |
Cover
| Abstract | 症例は54歳女性．20XX年4月，左半側空間無視と左片麻痺を主訴に前医へ救急搬送された．入院後の造影CTとMRI/MRA検査で右内頸動脈起始部閉塞による脳梗塞と深部静脈血栓症（DVT），粘液性卵巣癌を認めた．経胸壁心エコー（TTE）と経食道心エコー（TEE）では心腔内血栓を指摘できなかったが，心原性脳梗塞・奇異性脳塞栓の可能性が否定できず，直接経口抗凝固薬（DOAC）内服が開始された．この際に指摘された卵巣癌に対して7月，当院で卵巣摘出術を施行した．血栓イベント高リスクであるため，術中TEEを施行し，僧帽弁前尖および後尖に10 mm程度の可動性を有する構造物を認めた．形態より感染性心内膜炎を疑い抗生剤投与を開始したが複数回にわたる血液培養はすべて陰性であり感染徴候を示唆する臨床所見も認めなかった．疣腫の外科的切除も検討したが，非細菌性血栓性心内膜炎（NBTE）の可能性を考慮してヘパリンの投与を施行した．1週間後のTEEでは疣腫の縮小を認め，2週間後のTTEでは疣腫の消失を確認しNBTEと診断した．NBTEは悪性腫瘍などを基礎疾患に持ち，無菌性の血栓が弁膜に付着する．悪性腫瘍合併の疣腫ではNBTEの可能性を考慮する必要がある． |
|---|---|
| AbstractList | 症例は54歳女性．20XX年4月，左半側空間無視と左片麻痺を主訴に前医へ救急搬送された．入院後の造影CTとMRI/MRA検査で右内頸動脈起始部閉塞による脳梗塞と深部静脈血栓症（DVT），粘液性卵巣癌を認めた．経胸壁心エコー（TTE）と経食道心エコー（TEE）では心腔内血栓を指摘できなかったが，心原性脳梗塞・奇異性脳塞栓の可能性が否定できず，直接経口抗凝固薬（DOAC）内服が開始された．この際に指摘された卵巣癌に対して7月，当院で卵巣摘出術を施行した．血栓イベント高リスクであるため，術中TEEを施行し，僧帽弁前尖および後尖に10 mm程度の可動性を有する構造物を認めた．形態より感染性心内膜炎を疑い抗生剤投与を開始したが複数回にわたる血液培養はすべて陰性であり感染徴候を示唆する臨床所見も認めなかった．疣腫の外科的切除も検討したが，非細菌性血栓性心内膜炎（NBTE）の可能性を考慮してヘパリンの投与を施行した．1週間後のTEEでは疣腫の縮小を認め，2週間後のTTEでは疣腫の消失を確認しNBTEと診断した．NBTEは悪性腫瘍などを基礎疾患に持ち，無菌性の血栓が弁膜に付着する．悪性腫瘍合併の疣腫ではNBTEの可能性を考慮する必要がある． |
| Author | Kubota, Naoki Ishizuka, Mituo Takano, Toshiki Okubo, Takeshi Hoyano, Makoto Ozaki, Kazuyuki Kimura, Shinpei Yanagawa, Takao Kashimura, Takeshi Minamino, Tohru Kasahara, Shunya |
| Author_FL | 高野 俊樹 柳川 貴央 久保田 直樹 柏村 健 木村 新平 南野 徹 笠原 峻也 尾崎 和幸 大久保 健志 石塚 光夫 保屋野 真 |
| Author_FL_xml | – sequence: 1 fullname: 笠原 峻也 – sequence: 2 fullname: 高野 俊樹 – sequence: 3 fullname: 石塚 光夫 – sequence: 4 fullname: 久保田 直樹 – sequence: 5 fullname: 大久保 健志 – sequence: 6 fullname: 木村 新平 – sequence: 7 fullname: 保屋野 真 – sequence: 8 fullname: 柳川 貴央 – sequence: 9 fullname: 柏村 健 – sequence: 10 fullname: 尾崎 和幸 – sequence: 11 fullname: 南野 徹 |
| Author_xml | – sequence: 1 fullname: Yanagawa, Takao organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Okubo, Takeshi organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Ozaki, Kazuyuki organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Kashimura, Takeshi organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Kasahara, Shunya organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Kimura, Shinpei organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Hoyano, Makoto organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Ishizuka, Mituo organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Takano, Toshiki organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Kubota, Naoki organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: Minamino, Tohru organization: Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences |
| BackLink | https://cir.nii.ac.jp/crid/1390574975904971648$$DView record in CiNii |
| BookMark | eNo9kMFLwzAUh4MoOOeunnPw2pk0SZvcHGM6YTiQocfymqY2o01GEoT511s38fK93-N9vMPvBl067wxCd5TMKc0lfYiddd9-LthcKXmBJjmVRcYILS7RhIgxcy7lNZrFaGtCiCypUmyC0qt3NehkgoUe77rgh9onq_HKNV5DaGyyEb-Ds7EzDV764dCbZPoj_rCpw2tzgGAdXjSDHZUUIFnvMLgGv5lo9GnzLd5-jRo4vASnTbhFVy300cz-5hTtnla75TrbbJ9flotNtpeFzGihcyZKwxXNBQdKNS81lSXnjEktNJG0zEULbaFpraRpa5KPGVhrQNSiZVN0f37rrK20_SVlioiSq1IoMpIWXI7a41nbxwSfpjoEO0A4VhDGHnpTnZutBKvUCUr-n3QHoTKO_QB573fX |
| ContentType | Journal Article |
| Copyright | 2021 Japan Heart Foundation |
| Copyright_xml | – notice: 2021 Japan Heart Foundation |
| DBID | RYH |
| DOI | 10.11281/shinzo.53.998 |
| DatabaseName | CiNii Complete |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| DocumentTitleAlternate | 卵巣腫瘍摘出とヘパリン投与が奏功した非細菌性血栓性心内膜炎の1例 |
| DocumentTitle_FL | 卵巣腫瘍摘出とヘパリン投与が奏功した非細菌性血栓性心内膜炎の1例 |
| EISSN | 2186-3016 |
| EndPage | 1004 |
| ExternalDocumentID | article_shinzo_53_9_53_998_article_char_en |
| GroupedDBID | ALMA_UNASSIGNED_HOLDINGS JSF KQ8 MOJWN RJT RYH |
| ID | FETCH-LOGICAL-j868-16c2357e491254a11c47c18744338c5c081725faf6c1b98efb02f6ca3fea5b5f3 |
| ISSN | 0586-4488 |
| IngestDate | Thu Jun 26 23:12:45 EDT 2025 Wed Sep 03 06:31:03 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 9 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j868-16c2357e491254a11c47c18744338c5c081725faf6c1b98efb02f6ca3fea5b5f3 |
| ORCID | 0000-0003-1627-6151 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/shinzo/53/9/53_998/_article/-char/en |
| PageCount | 7 |
| ParticipantIDs | nii_cinii_1390574975904971648 jstage_primary_article_shinzo_53_9_53_998_article_char_en |
| PublicationCentury | 2000 |
| PublicationDate | 2021/09/15 2021-09-15 |
| PublicationDateYYYYMMDD | 2021-09-15 |
| PublicationDate_xml | – month: 09 year: 2021 text: 2021/09/15 day: 15 |
| PublicationDecade | 2020 |
| PublicationTitle | Shinzo |
| PublicationTitleAlternate | Shinzo |
| PublicationTitle_FL | 心臓 Shinzo |
| PublicationYear | 2021 |
| Publisher | Japan Heart Foundation 公益財団法人 日本心臓財団 |
| Publisher_xml | – name: Japan Heart Foundation – name: 公益財団法人 日本心臓財団 |
| References | 5) de Bruijn SF, Agema WR, Lammers GJ, et al：Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke 2006；37：2531-2534 15) Agnelli G, Becattini C, Meyer G, et al：Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 2020；382：1599-1607 4) Roldan CA, Sibbitt WL Jr, Qualls CR, et al：Libman-Sacks endocarditis and embolic cerebrovascular disease. JACC Cardiovasc Imaging 2013；6：973-983 8) Yamashiro K, Furuya T, Noda K, et al：Cerebral infarction developing in a patient without cancer with a markedly elevated level of mucinous tumor marker. J Stroke Cerebrovasc Dis 2012；21：619 10) 藤田純一，蔵本健矢，嶋田貴文，ほか：原疾患の治療がTrousseau症候群に奏功した肺腺癌の2例．日呼吸会誌2017；6：13-17 11) Lopez JA, Ross RS, Fishbein MC, Siegel RJ：Nonbacterial thrombotic endocarditis：A review. Am Heart J 1987；113：773-784 9) 森田聡美，牛若昂志，池上信夫：Trousseau症候群を発症するも集学的治療により手術・化学療法を完遂した原発性卵巣癌の一例．現代産婦人科2015；64：95-100 1) 野川 茂：がんと脳梗塞─トルーソー症候群の臨床．日血栓止血会誌2016；27：18-28 7) el-Shami K, Griffiths E, Streiff M：Nonbacterial thrombotic endocarditis in cancer patient：pathogenesis, diagnosis, and treatment. Oncologist 2007；12：518-523 14) Carrier M, Abou-Nassar K, Mallick R, et al：Apixaban to prevent venous thromboembolism in patient with cancer. N Engl J Med 2019；380：711-719 12) Yoshida K, Kimura T, Aburakawa Y, et al：Recurrent ischemic stroke in a patient with the Trousseau syndrome treated with dabigatran. J Stroke Cerebrovasc Dis 2014；23：1724-1726 3) Raoult D, Sexton DJ：Culture-negative endocarditis：Epidemiology, microbiology, and diagnosis. In：UpToDate, Calderwood SB, Baron EL(Ed), Waltham MA, UpToDate Inc. https://www.uptodate.com/contents/culture-negative-endocarditis-epidemiology-microbi ology-and-diagnosis(cited 2020 Apr 04 13) Raskob GE, van Es N, Verthamme P, et al：Edoxaban for the treatment of Cancer-associated venous thromboembolism. N Engl J Med 2018；378：615-624 2) 内山真一郎：トルーソー症候群．日内会誌2008；97：1805-1808 6) Joffe II, Jacobs LE, Owen AN, et al：Noninfective valvular masses：review of the literature with emphasis on imaging techniques and management. Am Heart J 1996；131：1175-1183 |
| References_xml | – reference: 15) Agnelli G, Becattini C, Meyer G, et al：Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 2020；382：1599-1607 – reference: 9) 森田聡美，牛若昂志，池上信夫：Trousseau症候群を発症するも集学的治療により手術・化学療法を完遂した原発性卵巣癌の一例．現代産婦人科2015；64：95-100 – reference: 7) el-Shami K, Griffiths E, Streiff M：Nonbacterial thrombotic endocarditis in cancer patient：pathogenesis, diagnosis, and treatment. Oncologist 2007；12：518-523 – reference: 3) Raoult D, Sexton DJ：Culture-negative endocarditis：Epidemiology, microbiology, and diagnosis. In：UpToDate, Calderwood SB, Baron EL(Ed), Waltham MA, UpToDate Inc. https://www.uptodate.com/contents/culture-negative-endocarditis-epidemiology-microbi ology-and-diagnosis(cited 2020 Apr 04) – reference: 13) Raskob GE, van Es N, Verthamme P, et al：Edoxaban for the treatment of Cancer-associated venous thromboembolism. N Engl J Med 2018；378：615-624 – reference: 5) de Bruijn SF, Agema WR, Lammers GJ, et al：Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke 2006；37：2531-2534 – reference: 1) 野川 茂：がんと脳梗塞─トルーソー症候群の臨床．日血栓止血会誌2016；27：18-28 – reference: 10) 藤田純一，蔵本健矢，嶋田貴文，ほか：原疾患の治療がTrousseau症候群に奏功した肺腺癌の2例．日呼吸会誌2017；6：13-17 – reference: 2) 内山真一郎：トルーソー症候群．日内会誌2008；97：1805-1808 – reference: 4) Roldan CA, Sibbitt WL Jr, Qualls CR, et al：Libman-Sacks endocarditis and embolic cerebrovascular disease. JACC Cardiovasc Imaging 2013；6：973-983 – reference: 12) Yoshida K, Kimura T, Aburakawa Y, et al：Recurrent ischemic stroke in a patient with the Trousseau syndrome treated with dabigatran. J Stroke Cerebrovasc Dis 2014；23：1724-1726 – reference: 8) Yamashiro K, Furuya T, Noda K, et al：Cerebral infarction developing in a patient without cancer with a markedly elevated level of mucinous tumor marker. J Stroke Cerebrovasc Dis 2012；21：619 – reference: 11) Lopez JA, Ross RS, Fishbein MC, Siegel RJ：Nonbacterial thrombotic endocarditis：A review. Am Heart J 1987；113：773-784 – reference: 14) Carrier M, Abou-Nassar K, Mallick R, et al：Apixaban to prevent venous thromboembolism in patient with cancer. N Engl J Med 2019；380：711-719 – reference: 6) Joffe II, Jacobs LE, Owen AN, et al：Noninfective valvular masses：review of the literature with emphasis on imaging techniques and management. Am Heart J 1996；131：1175-1183 |
| SSID | ssib000871993 ssib005879815 ssib058494393 ssj0000605722 ssib002822027 |
| Score | 2.279232 |
| Snippet | 症例は54歳女性．20XX年4月，左半側空間無視と左片麻痺を主訴に前医へ救急搬送された．入院後の造影CTとMRI/MRA検査で右内頸動脈起始部閉塞による脳梗塞と深部静脈血栓... |
| SourceID | nii jstage |
| SourceType | Publisher |
| StartPage | 998 |
| SubjectTerms | がん関連性血栓症 非細菌性血栓性心内膜炎 |
| Title | Nonbacterial Thrombotic Endocarditis Vanished Completely With Heparin Administration and Resection of Ovarian Cancer |
| URI | https://www.jstage.jst.go.jp/article/shinzo/53/9/53_998/_article/-char/en https://cir.nii.ac.jp/crid/1390574975904971648 |
| Volume | 53 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | Shinzo, 2021/09/15, Vol.53(9), pp.998-1004 |
| journalDatabaseRights | – providerCode: PRVAFT databaseName: Open Access Digital Library customDbUrl: eissn: 2186-3016 dateEnd: 99991231 omitProxy: true ssIdentifier: ssj0000605722 issn: 0586-4488 databaseCode: KQ8 dateStart: 19690101 isFulltext: true titleUrlDefault: http://grweb.coalliance.org/oadl/oadl.html providerName: Colorado Alliance of Research Libraries |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1db9MwFLW68cILAgFiwJAf8FOV0iR2bD-mVaYJtCG0gvYW2W6iph0JalOk9b_x37hO0saDSXxIkWXZiZX4nhyfa9nXCL3lws-opIE31zrzqBlTT0V-5plgHhjJjdZNtP2Ly-j8M31_za4Hgx_OqqVtrUdmd---kv-xKpSBXe0u2X-w7KFRKIA82BdSsDCkf2Xjy6rUbbTlZpf9uvqqKxuANSnnMESB6etiM_yiSrvufd78-mCl7OYWuKBewIhjTyAsf4mf2-1Y3GRmryU_fofbgAamFiBrV81eLYpyVx04W22UDf88vFpsy9sD3c_USpXVcFZtFsWq6KG4KHbblRpeFPW2b2ILH6CA8qvuzm4-IvDt4ol2R2aDIJIwIhiJpyThRE6IiEkiyCQgsW-roCQOSRKRSUgkIwklkxiuoS2SnMSsyUyb5xmZnBER2ucFtBX-3pBDlkxEHriaLZdnTZk9bssDAotctmehg2rpULeUwlEBNpDe_SNMIOwQs2k6eMTCETx3hB4EMKjYk0M-fHLVLbfLI13v1k419fQnuHRC5YAUlCAPw8MU4RhczS6U5_7rurCj9iXe3XkFEFBLcCdsnIijsigcjTR7jB51zg2OW6Q-QYOleopqF6W4Ryl2UYr3KMU9SrFFKe5Qiu-iFANK8QGluMpxh1LcovQZmp0ls-m515314S1FJDw_MjbuEtAGCG6qfN9QbuxxkTQMhWEGhCsPWK7yyPhaiizX4wDyKswzxTTLw-fouKzK7AXCiqucswy0mZEUHHTBNaWaG5DWcj6n7ATJtqfSb208l7T7f9O2Q1MWprJJpDhU2S2QwDgn6BQ6NzWFTcF3AvtQyZkEN9vOO4iXf6h_hR72v8xrdFyvt9kpiNpav2mg8xMx25Lt |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Nonbacterial+Thrombotic+Endocarditis+Vanished+Completely+With+Heparin+Administration+and+Resection+of+Ovarian+Cancer&rft.jtitle=Shinzo&rft.au=Kasahara+Shunya&rft.au=Takano+Toshiki&rft.au=Ishizuka+Mituo&rft.au=Kubota+Naoki&rft.date=2021-09-15&rft.pub=%E5%85%AC%E7%9B%8A%E8%B2%A1%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E5%BF%83%E8%87%93%E8%B2%A1%E5%9B%A3&rft.issn=0586-4488&rft.eissn=2186-3016&rft.volume=53&rft.issue=9&rft.spage=998&rft.epage=1004&rft_id=info:doi/10.11281%2Fshinzo.53.998 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0586-4488&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0586-4488&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0586-4488&client=summon |