Here are flat, pale tan, spreading vegetations over the
mitral valve surface and even on the chordae tendineae. This patient has
systemic lupus erythematosus. Thus, these vegetations that can be on any
valve or even on endocardial surfaces are consistent with Libman-Sacks
endocarditis.
These vegetations appear in about 4% of SLE patients and
rarely cause problems because they are not large and rarely embolize. Note
also the thickened, shortened, and fused chordae tendineae that represent
remote rheumatic heart disease.
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