Table 3.

Red flags in the differential diagnosis of NBTE.

1. Does the patient have a history of (a) cancer or (b) systemic autoimmune disease (especially SLE or APS)? Or does the patient’s history/physical examination suggest these conditions (e.g., unexplained weight loss, symptoms attributable to specific neoplasms, history of venous/arterial thrombosis, history of recurrent miscarriage, skin rash, etc.)?

2. Has the patient presented with an episode of arterial embolization, and in particular:         (a) multiple infarcts?         (b) cerebral infarcts?         (c) splanchnic infarcts?

3. Are endocardial masses located in the left-sided heart valves (especially the mitral)?

4. Is the patient afebrile? Does the patient have any other sign or symptom of infection (e.g., persistent low-back pain suggesting spondylodiscitis, meningeal or neurological signs suggestive of central nervous system dissemination of microorganisms)?

5. Does the patient manifest any signs that may suggest infective endocarditis, e.g., Roth’s spots, Janeway’s lesions, Osler’s nodules, periungual microhemorrhages?

6. Has the patient ever tested positive for antiphospholipid antibodies or connective tissue disease-associated autoantibodies?