LSE should be considered in instances of thromboembolic event in persons with underlying pathology that is associated with LSE. LSE is diagnosed with echocardiography. Other potential etiologies (e.g. infective endocarditis) should be excluded through an extensive assessment (complete blood count and metabolic panel, blood cultures). LSE can also be identified post-mortem during an autopsy. Echocardiography Echocardiography is considered the primary evaluation for LSE; transesophageal echocardiography (TEE) has greater sensitivity and specificity than transthoracic echocardiography (TTE). In case of a negative TTE in the presence of clinical signs of LSE, TEE may be attempted to confirm the presence of the condition. Vegetations of the cardiac valves and endocardium are characterised by irregular borders, heterogenous echo density, and an absence of independent motion. Vegetations are usually small, but may be as large as 10mm. The basal and middle portions of the mitral and aortic valves are most commonly involved. Leaflet thickening or regurgitation may be present. There may be other cardiac pathology related to the underlying cause (SLE). Differential diagnosis Differential diagnoses include: rheumatic valvular disease, atrial myxoma, degenerative valvular disease, infective endocarditis, vasculitis, cholesterol emboli syndrome, fibroelastoma, and Lambl's excrescences.
Libman–Sacks endocarditis
Loeffler endocarditis
Nonbacterial thrombotic endocarditis
Infective endocarditis
Subacute bacterial endocarditis
Tuberculous pericarditis
Nocardiosis
Coronary artery aneurysm