- by Medikoe Health Expert
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- Feb 09 2017
Nonbacterial thrombotic endocarditis
Non-bacterial thrombotic endocarditis (NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the valve leaflets. Formerly known asmarantic endocarditis, which comes from the Greek marantikos, meaning “wasting away.” The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state such as cancer.
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.
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 the following predilection:
aortic valve > mitral valve > tricuspid valve > pulmonary valve
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 the diagnosis of NBTE. An echocardiograph may be used to further assess for valvular lesions.
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