Embolic Stroke Unveiling Lung Cancer: A Case of Cancer-Associated Non-bacterial Thrombotic Endocarditis

Figures

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  Figure 1. Cranial CT (coronal plane on the left and axial plane on the right): the blue arrow indicates an occipital infarction, while the red arrow highlights a small cortical parietal infarction in a different arterial territory.

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  Figure 2. Cranial CT (axial plane): the green arrow indicates small focal lesions in the centrum semiovale.

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  Figure 3. Brain MRI (DWI (left) and FLAIR (right) axial views): left occipital infarction and small contralateral occipital cortical lesions. DWI: Diffusion-Weighted Imaging, FLAIR: Fluid-Attenuated Inversion Recovery

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  Figure 4. Axial DWI (left) and FLAIR (right) images – multiple recent ischemic lesions in the centrum semiovale, forming a bilateral "line" pattern, suggestive of watershed stroke. DWI: Diffusion-Weighted Imaging, FLAIR: Fluid-Attenuated Inversion Recovery

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  Figure 5. Transesophageal echocardiography showing a heterogeneous mass on the mitral valve.

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  Figure 6. CT scan with a pulmonary mass in the right upper lobe.

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  Figure 7. Cytological result of transcranial puncture (A) and transbronchial puncture (B) positive for neoplastic cells compatible non-small cell carcinoma. (A, transcranial) High cellularity, with a fibrin background, lymphocytes, occasional polymorphonuclear cells, bronchial cells, and numerous neoplastic cells, both isolated and in clusters, sometimes tridimensional, with an increased nucleus/cytoplasm ratio, dense cytoplasm, anisokaryosis, coarse chromatin, and prominent macronucleoli. (B, transbronchial): Moderate cellularity, composed of lymphocytes, occasional polymorphonuclear cells, numerous bronchial cells, and clusters of neoplastic cells, sometimes tridimensional, with dense cytoplasm, anisokaryosis, coarse chromatin, and prominent macronucleoli.