Exploring the Complexities of Non-Bacterial Thrombotic Endocarditis: Highlights from Literature and Case Studies

Figures

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  Figure 1. Timeline summarizing the main clinical events from Case 1, chronologically described.

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  Figure 2. (A,B) Mid-esophageal transesophageal echocardiogram (TEE) views showing an iso-echogenic mass on P2 scallop tip (yellow narrow) and a thickened A2 edge (red narrow). (C) Three-dimensional TEE multiplanar reconstruction focused on P2 lesion size: 9.6 mm in length, area of 48 mm2. (D,E) Three-dimensional TEE-true view technique—a live 3D TEE (E) and a 3D “zoom” surgical view—(F) showing mitral valve lesions on both atrial (yellow narrows) and ventricular sides (red narrow). (F) A moderate mitral valve regurgitation in a 3D TEE multiplanar reconstruction: Proximal Isovelocity Surface Area (PISA) radius = 6 mm, VCA (vena contracta area) 3D = 0.3 cm2.

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  Figure 3. A large mass in the right pelvic region exhibiting widespread and non-uniform 18F-FDG on the PET/CT scan.

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  Figure 4. Event timeline from case 2.

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  Figure 5. On the left, the huge echo-dense mass along the free edge of the P2 scallop (yellow narrow) in a 3D “zoom” surgical view and in a 3D TEE multiplanar reconstruction, in the middle, measuring 17 × 4.7 mm and covering an area of 98 mm2. On the right, NBTE vegetation (yellow narrow) seen in a 3D “zoom” TEE view (lateral perspective-true view technique).

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  Figure 6. On the right, a 3D TEE multiplanar reconstruction showing a moderate mitral valve regurgitation (PISA radius = 6.9 mm, VCA 3D = 0.328 cm2] with an eccentric anterior direction, as seen on the left in a lateral perspective 3D “zoom” TEE acquisition—glass technique.

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  Figure 7. Twelve-month TEE follow-up showing a significant decrease in NBTE lesion: 14 × 3.5 mm, area of 0.59 cm2 in a 3D TEE multiplanar reconstruction.

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  Figure 8. Event timeline from Case 3.

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  Figure 9. (A) A 60° mid-esophageal TEE view showing a verrucous big mass on the mitral valve (yellow narrow). (B,C) Verrucous vegetations (yellow narrows) along the entire coaptation surface of both mitral leaflets in 3D “zoom” TEE acquisitions. (D) The severe mitral regurgitation on 2D TEE.

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  Figure 10. 18F–FDG–PET/CT scan revealing a significantly abnormal metabolic uptake within a left pulmonary lesion, on the left, also involving adrenal glands, lymph nodes and bone sites, on the right.

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  Figure 11. A simplified flow-chart for NBTE management work-up.

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  Figure 12. A tailored antithrombotic approach.