Non-bacterial thrombotic endocarditis echocardiography and ultrasound: Difference between revisions

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{{Non-bacterial thrombotic endocarditis}}
{{Non-bacterial thrombotic endocarditis}}
{{CMG}}; {{AE}}{{Homa}}
{{CMG}}; {{AE}}{{Aisha}}
==Overview==
==Overview==


There are no echocardiography/ultrasound findings associated with [disease name].
[[Echocardiography]] may be helpful in the [[diagnosis]] of [[non-bacterial thrombotic endocarditis]]. It is especially important in visualizing [[Cardiac valve|valvular]] [[Vegetation (pathology)|vegetations]] suggestive of NBTE. Although echocardiography is important in the diagnosis of vegetations in cardiac valves, it does not differentiate vegetations due to [[Infective endocarditis|thrombotic infection]] from vegetations as a result of [[Aggregation|aggregations]] of [[platelets]] and [[Fibrin|fibrin.]]


OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Patients with suspected NBTE should be evaluated with two-dimensional transthoracic echocardiography (TTE) for the presence of valvular vegetations [11,12]. Vegetations are frequently left-sided with two-thirds of cases involving the mitral valve, up to a quarter involving the aortic, and less commonly both valves [2,3,7,10]. Cases with all four valves affected by NBTE have also been reported [28,29]. Should TTE be unrevealing, proceeding to transesophageal echocardiography (TEE) should be considered in those who are suitable candidates. The purpose of echocardiography is the visualization of vegetations. However, echocardiography cannot distinguish vegetations due to thrombus or infection from those due to aggregations of platelets and fibrin as seen in NBTE.
TEE is more sensitive than TTE for the detection of vegetations, particularly for small lesions (<5 mm) [30]. This was best illustrated in a series of 51 consecutive cancer patients with cerebrovascular events who were referred for TEE [31]. Among those with nonbacterial vegetations (nine patients) who had also had a TTE and TEE, TTE missed vegetations in four cases.
TEE is an invasive procedure. Thus, the selection of patients suitable for TEE should be individualized according to performance status and life expectancy if the patient is known to have an underlying malignancy.


==Echocardiography/Ultrasound==
==Echocardiography/Ultrasound==


There are no echocardiography/ultrasound findings associated with [disease name].
*[[Echocardiography]] may be helpful in the [[diagnosis]] of [[non-bacterial thrombotic endocarditis]]<ref name="pmid8875919">{{cite journal |vauthors=Roldan CA, Shively BK, Crawford MH |title=An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus |journal=N. Engl. J. Med. |volume=335 |issue=19 |pages=1424–30 |date=November 1996 |pmid=8875919 |doi=10.1056/NEJM199611073351903 |url=}}</ref>. It is especially important in visualizing [[Cardiac valve|valvular]] [[Vegetation (pathology)|vegetations]] suggestive of NBTE<ref name="pmid18085739">{{cite journal |vauthors=Roldan CA, Qualls CR, Sopko KS, Sibbitt WL |title=Transthoracic versus transesophageal echocardiography for detection of Libman-Sacks endocarditis: a randomized controlled study |journal=J. Rheumatol. |volume=35 |issue=2 |pages=224–9 |date=February 2008 |pmid=18085739 |doi= |url=}}</ref>.
 
*Left sided valves are more commonly affected with 75% of cases seen in the [[mitral valve]]<ref name="urlNon-bacterial Thrombotic Endocarditis | IntechOpen">{{cite web |url=https://www.intechopen.com/books/infective-endocarditis/non-bacterial-thrombotic-endocarditis |title=Non-bacterial Thrombotic Endocarditis &#124; IntechOpen |format= |work= |accessdate=}}</ref>.
OR
*The vegetations in NBTE are typically <1cm, broad-based, and irregularly shaped<ref>Otto C.M.. Nonbacterial thrombotic endocarditis. Valvular heart disease, 1999 pp. 445–50
 
</ref>.
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include:
*Less commonly, vegetations have been found to involve all the cardiac valves<ref name="pmid7059307">{{cite journal |vauthors=Biller J, Challa VR, Toole JF, Howard VJ |title=Nonbacterial thrombotic endocarditis. A neurologic perspective of clinicopathologic correlations of 99 patients |journal=Arch. Neurol. |volume=39 |issue=2 |pages=95–8 |date=February 1982 |pmid=7059307 |doi=10.1001/archneur.1982.00510140029007 |url=}}</ref><ref name="pmid4374176">{{cite journal |vauthors=Reagan TJ, Okazaki H |title=The thrombotic syndrome associated with carcinoma. A clinical and neuropathologic study |journal=Arch. Neurol. |volume=31 |issue=6 |pages=390–5 |date=December 1974 |pmid=4374176 |doi=10.1001/archneur.1974.00490420056006 |url=}}</ref>.
*[Finding 1]
*[[Transesophageal echocardiography (TEE)|Transesophageal echocardiography]] is more [[Sensitivity (tests)|sensitive]] (90%) than [[transthoracic echocardiography]], especially for vegetations <5mm<ref name="pmid16946152">{{cite journal |vauthors=de Bruijn SF, Agema WR, Lammers GJ, van der Wall EE, Wolterbeek R, Holman ER, Bollen EL, Bax JJ |title=Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke |journal=Stroke |volume=37 |issue=10 |pages=2531–4 |date=October 2006 |pmid=16946152 |doi=10.1161/01.STR.0000241064.46659.69 |url=}}</ref>.
*[Finding 2]
*Because transesophageal echocardiography is an [[Invasive (medical)|invasive]] procedure, evaluation of patients with this modality should be cased-based.
*[Finding 3]
*The two-dimensional transesophageal echocardiography (2D-TEE) has a higher diagnostic value for the detection of vegetations in NBTE, however, the three-dimensional TEE (3D-TEE) has the following benefits over it:
 
**Improved [[Detection and Diagnosis in Adulthood|detection]]
OR
**Improved characterization
**Improved clinical correlations of NBTE vegetations
**Provides clinically relevant additive information complementing the 2D-TEE for the characterization, detection, and association with the cerebrovascular disease of NBTE endocarditis.
*Although echocardiography is important in the diagnosis of vegetations in cardiac valves, it does not differentiate vegetations due to [[Infective endocarditis|thrombotic infection]] from vegetations as a result of [[Aggregation|aggregations]] of [[platelets]] and [[Fibrin|fibrin.]]


There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include:
[[File:Cr534e-g002.jpg|thumb|400px|none|2D transesophageal ultrasound. Image on the left shows a thickened mitral valve with a 1 cm vegetation that can be seen on the anterior mitral leaflet. Image on the right is a four-chamber color flow Doppler view showing biventricular dilatation, severe left ventricular dysfunction. For orientation purposes, left ventricle is the bottom right chamber. Video of both views is attached as a supplementary file. [https://cardiologyres.org/index.php/Cardiologyres/article/view/551/592 Source: Ghulam Murtaza. et al, Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA]]]
*[Complication 1]
*[Complication 2]
*[Complication 3]


==References==
==References==

Latest revision as of 15:12, 25 August 2020

non-bacterial thrombotic endocarditis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

Echocardiography may be helpful in the diagnosis of non-bacterial thrombotic endocarditis. It is especially important in visualizing valvular vegetations suggestive of NBTE. Although echocardiography is important in the diagnosis of vegetations in cardiac valves, it does not differentiate vegetations due to thrombotic infection from vegetations as a result of aggregations of platelets and fibrin.


Echocardiography/Ultrasound

  • Echocardiography may be helpful in the diagnosis of non-bacterial thrombotic endocarditis[1]. It is especially important in visualizing valvular vegetations suggestive of NBTE[2].
  • Left sided valves are more commonly affected with 75% of cases seen in the mitral valve[3].
  • The vegetations in NBTE are typically <1cm, broad-based, and irregularly shaped[4].
  • Less commonly, vegetations have been found to involve all the cardiac valves[5][6].
  • Transesophageal echocardiography is more sensitive (90%) than transthoracic echocardiography, especially for vegetations <5mm[7].
  • Because transesophageal echocardiography is an invasive procedure, evaluation of patients with this modality should be cased-based.
  • The two-dimensional transesophageal echocardiography (2D-TEE) has a higher diagnostic value for the detection of vegetations in NBTE, however, the three-dimensional TEE (3D-TEE) has the following benefits over it:
    • Improved detection
    • Improved characterization
    • Improved clinical correlations of NBTE vegetations
    • Provides clinically relevant additive information complementing the 2D-TEE for the characterization, detection, and association with the cerebrovascular disease of NBTE endocarditis.
  • Although echocardiography is important in the diagnosis of vegetations in cardiac valves, it does not differentiate vegetations due to thrombotic infection from vegetations as a result of aggregations of platelets and fibrin.
2D transesophageal ultrasound. Image on the left shows a thickened mitral valve with a 1 cm vegetation that can be seen on the anterior mitral leaflet. Image on the right is a four-chamber color flow Doppler view showing biventricular dilatation, severe left ventricular dysfunction. For orientation purposes, left ventricle is the bottom right chamber. Video of both views is attached as a supplementary file. Source: Ghulam Murtaza. et al, Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA

References

  1. ↑ Roldan CA, Shively BK, Crawford MH (November 1996). "An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus". N. Engl. J. Med. 335 (19): 1424–30. doi:10.1056/NEJM199611073351903. PMID 8875919.
  2. ↑ Roldan CA, Qualls CR, Sopko KS, Sibbitt WL (February 2008). "Transthoracic versus transesophageal echocardiography for detection of Libman-Sacks endocarditis: a randomized controlled study". J. Rheumatol. 35 (2): 224–9. PMID 18085739.
  3. ↑ "Non-bacterial Thrombotic Endocarditis | IntechOpen".
  4. ↑ Otto C.M.. Nonbacterial thrombotic endocarditis. Valvular heart disease, 1999 pp. 445–50
  5. ↑ Biller J, Challa VR, Toole JF, Howard VJ (February 1982). "Nonbacterial thrombotic endocarditis. A neurologic perspective of clinicopathologic correlations of 99 patients". Arch. Neurol. 39 (2): 95–8. doi:10.1001/archneur.1982.00510140029007. PMID 7059307.
  6. ↑ Reagan TJ, Okazaki H (December 1974). "The thrombotic syndrome associated with carcinoma. A clinical and neuropathologic study". Arch. Neurol. 31 (6): 390–5. doi:10.1001/archneur.1974.00490420056006. PMID 4374176.
  7. ↑ de Bruijn SF, Agema WR, Lammers GJ, van der Wall EE, Wolterbeek R, Holman ER, Bollen EL, Bax JJ (October 2006). "Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke". Stroke. 37 (10): 2531–4. doi:10.1161/01.STR.0000241064.46659.69. PMID 16946152.

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