Libman-Sacks endocarditis: echocardiographic and histopathologic characteristics. A: This two-dimensional (2D) long-axis transesophageal echocardiographic.

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Presentation transcript:

Libman-Sacks endocarditis: echocardiographic and histopathologic characteristics. A: This two-dimensional (2D) long-axis transesophageal echocardiographic (TEE) view of the mitral valve in a 28-year-old woman with systemic lupus erythematosus (SLE) with acute confusional state and cognitive dysfunction demonstrates small, oval-shaped, and soft tissue echoreflectant Libman-Sacks vegetations (arrows) on the atrial side and tip portions of the anterior (aml) and posterior (pml) mitral leaflets with associated leaflet thickening and decreased mobility. Associated symptomatic severe mitral regurgitation was present. Therefore, the patient underwent mitral valve replacement. B: Diffuse leaflet thickening with a Libman-Sacks vegetation on the atrial side and tip portion of the anterior leaflet is noted (arrowhead). C: Vegetation attached to the leaflets (arrows) shows amorphous eosinophilic fibrinous to granular deposits admixed with histiocytes, inflammatory cells, and superficial microthrombi (arrowheads). The mitral leaflet shows focal areas of myxoid degeneration and fibrinoid necrosis but no inflammation. D: This 2D-TEE view of the mitral valve in a 26-year-old woman with SLE with past stroke and acute transient ischemic attack demonstrates small, sessile, and homogeneously hyperreflectant oval nodularities consistent with healed Libman-Sacks vegetations (arrows) on the left atrial (LA) side and distal portions of the anterior and posterior mitral leaflets associated with mild leaflet thickening and severely decreased mobility, predominantly of the posterior mitral leaflet. E: Photograph of the middle scallop of the posterior mitral leaflet (pml) demonstrates sessile, granular, protruding, grayish to brown discolored, clustered, and coalescent Libman-Sacks vegetations (arrowheads) located on the coaptation point and predominantly on the LA side. F: This hematoxylin and eosin histopathologic section of the posterior mitral leaflet demonstrates diffuse thickening predominant of the leaflet tip with a well-adhered vegetation mainly on the LA side (arrowheads), but also extending to the left ventricular (LV) side, where it appears organized and endothelialized. Source: Connective Tissue Diseases & the Heart, CURRENT Diagnosis & Treatment: Cardiology, 5e Citation: Crawford MH. CURRENT Diagnosis & Treatment: Cardiology, 5e; 2017 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/2040/cdtcard5_ch35_f001.png&sec=152997999&BookID=2040&ChapterSecID=152997983&imagename= Accessed: December 27, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved