Clinical and Therapeutic Considerations in Nonbacterial Thrombotic Endocarditis

Clinical manifestations and pathologic findings were correlated in 11 patients having nonbacterial thrombotic endocarditis (NBTE). Nine cases of adenocarcinoma were found, four of which were primary in the lung. Mucin production was found in only two tumors. The vegetations were on the mitral valve in ten, the aortic valve in four and the tricuspid valve in one. Arterial embolism was clinically manifest in ten patients and was the cause of death in five. Cerebral embolism occurred in seven patients and was diagnosed by angiography and brain scan three times. Myocardial infarction due to emboli occurred in two patients. Lower extremity ischemia due to emboli was seen in three patients and treated by embolectomy twice. Three patients had severe venous thrombosis: two requiring amputation, one of whom died suddenly from pulmonary embolism. We conclude that by awareness of NBTE and application of angiography or other diagnostic modalities, the diagnosis can be established antemortem when meaningful therapeutic intervention may be possible.