胰腺腺癌患者三尖瓣非细菌性血栓性心内膜炎并反复肺动脉栓塞：临床病例

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非细菌性血栓性心内膜炎是一种罕见疾病，通常呈无症状经过，且多在合并恶性肿瘤、系统性红斑狼疮或抗磷脂综合征患者的尸检中被发现。该病的心内膜赘生物主要累及左心系统。相对而言，非细菌性血栓性心内膜炎中三尖瓣的孤立性受累极为罕见，其该部位受累的发生频率尚未明确。

本文报道了一例胰腺腺癌并肝转移患者的非细菌性血栓性心内膜炎病例，其特点为三尖瓣的罕见孤立性受累，并在接受抗凝治疗的情况下仍反复发生肺动脉血栓栓塞。

本病例的诊疗难点在于：每次尝试短暂停止抗凝治疗时，均出现肺动脉血栓栓塞复发。而抗凝治疗的暂停又是安全实施转移灶活检并进行后续组织学验证的必要条件，缺乏病理学确认则无法启动充分的抗肿瘤治疗。

鉴于目前关于此类患者管理策略的文献资料极为有限，其治疗方案的制定需要高度个体化，并要求临床医生采取非标准化的决策。

作者简介

Kira S. Dalgatova

Olymp Clinic Mars

Email: kira_1975@mail.ru
ORCID iD: 0009-0007-3327-009X
俄罗斯联邦, Moscow

Mariya K. Alaniya

Ilinskiy Hospital

Email: malaniya17@gmail.com
ORCID iD: 0009-0009-6948-8183
俄罗斯联邦, Moscow

Sergey A. Fedorov

Ilinskiy Hospital

Email: serhiofedorucci@gmail.com
ORCID iD: 0000-0001-8214-9826
SPIN 代码: 9234-2015

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

Alexey D. Erlikh

Ilinskiy Hospital

Email: alexeyerlikh@gmail.com
ORCID iD: 0000-0003-0607-2673
SPIN 代码: 4697-0822

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Oleg P. Bliznyukov

Russian Scientific Center of Roentgenology and Radiology

Email: opblisnukov@mail.ru
ORCID iD: 0000-0003-2401-5007
SPIN 代码: 6182-0840

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Valentin E. Sinitsyn

Lomonosov Moscow State University; Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

编辑信件的主要联系方式.
Email: vsini@mail.ru
ORCID iD: 0000-0002-5649-2193
SPIN 代码: 8449-6590

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow; Moscow

参考

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2. Fig. 1. Computed tomography results, venous phase: a — transverse section, large tumour of the pancreas (arrow), multiple metastases in the liver; b — frontal reform, single right kidney with a small cyst in the lower pole.

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3. Fig. 2. Results of computed tomography angiopulmonography: a — obtained a week earlier, the arrow indicates complete occlusion of the lower lobe branch of the pulmonary artery; b — obtained during hospitalisation, partial restoration of blood flow in it, enlargement of the right chambers of the heart.

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4. Fig. 3. Results of the second computed tomography scan obtained during hospitalisation: a — sagittal reform, increased enlargement of the right heart chambers, leftward displacement of the interventricular septum; b — transverse section, arrows indicate small thickening at the tips of the tricuspid valve.

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5. Fig. 4. Echocardiography results, parasternal view, position of the right ventricular outflow tract: "warty" thickening of the tricuspid valve leaflets (red arrows).

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6. Fig. 5. Echocardiography results, parasternal view, modified short axis of the aortic valve with focus on the tricuspid valve: "warty" thickening of the tricuspid valve leaflets (green arrow).

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7. Fig. 6. Autopsy data: verrucous endocarditis, large vegetations on all leaflets of the tricuspid valve.

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