Nonbacterial thrombotic endocarditis

 ( Heart Diseases ) 

Nonbacterial thrombotic endocarditis ( NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the heart valve leaflets. Formerly known as marantic endocarditis, which comes from the Greek language , meaning "wasting away". The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state such as cancer.

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Risk factors Marantic vegetations are often associated with previous rheumatic fever. Other risk factors include:

• hypercoagulable states
• malignant cancers, especially mucin-producing (most commonly associated with pancreatic adenocarcinomas)
• systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis
• Physical trauma (e.g., catheters)
• Antiphospholipid syndrome

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Valve predilection The disease affects the valves with following predilection: mitral valve > aortic valve > tricuspid valve > pulmonary valve

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Histopathology Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verruca (warty) texture. histology, lesions are composed of fibrin (eosinophilic) and but, unlike etiologies, contain little evidence of PMNs, or inflammation.

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Diagnosis Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new heart murmurs. An embolic stroke may be the first feature to suggest diagnosis of NBTE. An echocardiogram is essential for visualization of the mass.

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