Which of the following have most friable vegetation:

Answer is A (Infective endocarditis) Most friable vegetations with the highest risk of embolization are seen in infective endocarditis. Friability of Vegetation and risk of embolization Infective Endocarditis > NBTE (Marantic) > Rheumatic endocarditis and Libman Sack's endocarditis Rheumatic Fever Non bacterial Thrombotic Libman Sack's Endocarditis Infective Endocarditis (Marantic Endocarditis) (SLE) * Small * Small (but larger than those * Medium sized(small) * Large, Bulky * Way, verrucous of rheumatic) * Flat, Verrucous,lrregular * Irregular * Usually Firm * Friable * Usually Firm; occasionally friable * Friable (most friable)Q May be friable (but less than those of NBTE) (embolization rare) (embolization common) (embolization rare) (embolization common) . * Along lines of closure * Along lines of closure * On surface of cusps Both surfaces may be involved most common being the undersurface, less often on mural endocardium * In pockets of valves * Irregular vegetations on valve cusps that can extend onto the chordae. * Less often on mural endocardium * Sterile (no organisms) * Sterile * Sterile * Non-sterile (bacteria) * Non destructive * Non destructive * Destructive * Destructive Valve perforation : no Valve perforation : no Valve perforation : no Ulcerates or perforates Mural involvement: rare Mural involvement: rare Mural involvement: common underlying valve (or myocardium) * Seen in Rheumatic fever * Seen in hyper coagulable states e.g. cancer, promyelocytic leukemia increased estrogenic state * Seen in SLE * Seen in Infective endocarditis Most common site: Most common site for vegetations in Libman Sack's endocarditis are the A-V values, mitral and tricuspid. Most common site for vegetations in NBTE is mitral and less often aoic and Tricuspid. Most common site for vegetations of RF is mitral followed by combined mitral and aoic.