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, 4 of which were primary in the lung. Mucin production was found in only 2 tumors. The vegetations were on the mitral valve in 10, the aortic valve in 4 and the tricuspid valve in one. Arterial embolism was clinically manifest in 10 patients and was the cause of death in 5. Cerebral embolism occurred in 7 patients and was diagnosed by angiography and brain scan 3 times. Myocardial infarction due to emboli occurred in 2 patients. Lower extremity ischemia due to emboli was seen in 3 patients and treated by embolectomy twice. Three patients had severe venous thrombosis: 2 requiring amputation, one of whom died suddenly from pulmonary embolism. It is concluded 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.