A 28-year-old woman suffering from headache and blurred vision was admitted to the hospital. Physical examination revealed numerous splinter hemorrhages in the nail beds of the hands (Figure 1). Her neurologic examination revealed left inferior homonymous quadrantanopia. A magnetic resonance imaging scan revealed numerous acute infarcts. Transesophageal echocardi-ography revealed a 1-cm nonoscillating mass on the tricuspid valve (Figure 2) and a 1-cm nonoscillating mass on the mitral valve. A chest/abdomen/pelvis computed tomography scan showed multiple hepatic masses and an 8-cm cystic mass in the pancreas (Figure 3). Pathologic examination revealed nonsmall cell carcinoma with papillary and tubular architecture. The workup concluded with a diagnosis of nonbacterial thrombotic endocarditis caused by metastatic pancreatic exocrine cancer. Lifelong low molecular weight heparin was given to prevent further embolism.
展开▼
