Nonbacterial thrombotic endocarditis

Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the valve leaflets. Formerly known as marantic endocarditis, which comes from the Greek , meaning "wasting away". The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state such as cancer. Marantic vegetations are often associated with previous rheumatic fever. Other risk factors include: hypercoagulable states malignant cancers, especially mucin-producing adenocarcinomas (most commonly associated with pancreatic adenocarcinomas) systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis trauma (e.g., catheters) The disease affects the valves with following predilection: mitral valve > aortic valve > tricuspid valve > pulmonary valve Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verrucoid (warty) texture. Histologically, lesions are composed of fibrin (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation. Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new murmur. An embolic stroke may be the first feature to suggest diagnosis of NBTE. An echocardiograph may be used to further assess for valvular lesions.