Clinical features and diagnostic investigations differentiating NBTE from infective endocarditis
| NBTE | Infective endocarditis | |
| Predisposing conditions: | Autoimmune (SLE/APLS) | Underlying valve pathology |
| Malignancy | History of intravenous drug use | |
| Hypercoagulable states | Central lines/indwelling catheters | |
| Clinical features: | ||
| Fever | – | + |
| Systemic embolism | +++ | + |
| Heart failure | – (rare) | ++ |
| Valve dysfunction | + | +++ |
| Blood cultures/serology | Serial negative blood cultures | + (Negative blood cultures in up to 30% of cases) |
| Echocardiographic features: | Frequent false-negative results: vegetation may have already embolised Vegetations often small (<1 cm), broad based and irregular in shape Predilection for left-sided heart valves | Mobile mass of variable location Valve destruction/dysfunction common Aortic root abscess often seen |
| MRI brain for cerebral emboli | Multiple, small disseminated infarcts | Usually single territory large infarct |
NBTE, non-bacterial thrombotic endocarditis.