A 40-year-old woman has had a 10-kg weight loss accompanied by severe nausea and vomiting of...

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A 40-year-old woman has had a 10-kg weight loss accompanied by severe nausea and vomiting of blood for the past 8 months. On physical examination, she is afebrile. Her pulse is 91/min, respirations are 19/min, and blood pressure is 90/50 mm Hg. Laboratory studies show hemoglobin, 8.4 g/dL; platelet count, 227,100/mm³; and WBC count, 6180/mm³. Biopsy specimens obtained by upper gastrointestinal endoscopy show adenocarcinoma of the stomach. CT scan of the abdomen shows multiple hepatic masses. CT scan of the head shows a cystic area in the right frontal lobe. The patient's condition is stable until 2 weeks later, when she develops severe dyspnea. A pulmonary ventilation-perfusion scan shows a high probability of pulmonary thromboembolism. Which of the following cardiac lesions is most likely to be present? (A) Epicardial metastas es (B) Left ventricular mural thrombosis (C) Constrictive pericarditis (D) Nonbacterial thrombotic endocarditis (E) Calcific aortic valvular stenosis A 40-year-old woman has had a 10-kg weight loss accompanied by severe nausea and vomiting of blood for the past 8 months. On physical examination, she is afebrile. Her pulse is 91/min, respirations are 19/min, and blood pressure is 90/50 mm Hg. Laboratory studies show hemoglobin, 8.4 g/dL; platelet count, 227,100/mm³; and WBC count, 6180/mm³. Biopsy specimens obtained by upper gastrointestinal endoscopy show adenocarcinoma of the stomach. CT scan of the abdomen shows multiple hepatic masses. CT scan of the head shows a cystic area in the right frontal lobe. The patient's condition is stable until 2 weeks later, when she develops severe dyspnea. A pulmonary ventilation-perfusion scan shows a high probability of pulmonary thromboembolism. Which of the following cardiac lesions is most likely to be present? (A) Epicardial metastas es (B) Left ventricular mural thrombosis (C) Constrictive pericarditis (D) Nonbacterial thrombotic endocarditis (E) Calcific aortic valvular stenosis

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