Non-bacterial thrombotic endocarditis echocardiography and ultrasound

non-bacterial thrombotic endocarditis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]

Overview

There are no echocardiography/ultrasound findings associated with [disease name].

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

There are no echocardiography/ultrasound findings associated with [disease name].

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]
• [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]
• [Complication 3]