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 Template:Transliteration, meaning "wasting away".<ref>Template:EMedicine</ref> The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> such as cancer.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Risk factors

Marantic vegetations are often associated with previous rheumatic fever. Other risk factors include:Template:Citation needed

• 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)
• Antiphospholipid syndrome

Valve predilection

The disease affects the valves with following predilection: mitral valve > aortic valve > tricuspid valve > pulmonary valve<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Histopathology

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<ref>Template:DorlandsDict</ref> (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.Template:Citation needed

Diagnosis

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 echocardiogram is essential for visualization of the mass.Template:Citation needed