Nonbacterial Thrombotic Endocarditis of the Aortic Valve Secondary to Urothelial Carcinoma With Pancreatic Metastases

A 72-year-old male with a medical history significant for ischemic cardiomyopathy, prostate cancer, and peripheral vascular disease presented with jaundice, progressive frailty, and anemia. Transthoracic echocardiography identified a new aortic valve vegetation. Comprehensive infectious evaluation yielded negative results, and cardiac magnetic resonance (CMR) imaging demonstrated a non-enhancing lesion involving the aortic valve. Given the negative infectious evaluation and absence of systemic signs of infection, a diagnosis of nonbacterial thrombotic endocarditis (NBTE) was favored. Concurrent imaging revealed pancreatic involvement by metastatic urothelial carcinoma. Anticoagulation therapy was initiated but subsequently discontinued due to the development of symptomatic anemia and thrombocytopenia. This case underscores the diagnostic utility of CMR in characterizing valvular lesions and emphasizes the importance of malignancy screening in patients with suspected NBTE. A multidisciplinary approach enabled the formulation of a patient-centered management strategy within the context of advanced malignancy.