In non-bacterial thrombotic endocarditis (NBTE / marantic endocarditis), vegetations most commonly occur on which valvular surface and in which patient populations?

• A Irregular shaggy vegetations on the tricuspid valve in IV drug users
• B Small, sterile vegetations on the valve closure line of the mitral valve in hypercoagulable/debilitated patients ✓
• C Verrucous vegetations on both surfaces of the mitral valve in SLE (Libman-Sacks)
• D Destructive large vegetations at the base of aortic leaflets in acute infective endocarditis

Explanation

Non-bacterial thrombotic endocarditis features small, sterile, bland vegetations composed of fibrin and platelets on the line of valve closure (atrial surface of AV valves, ventricular surface of semilunar valves), most commonly the mitral valve. They occur in hypercoagulable states, chronic debilitating illnesses (cancer, sepsis), and mucin-secreting adenocarcinomas (Trousseau-associated). Unlike infective endocarditis, vegetations are sterile, non-destructive, and rarely cause valve dysfunction, but are a source of bland systemic emboli. Libman-Sacks endocarditis in SLE characteristically affects both sides of the mitral leaflets.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.