<prompt> Which of the following have most friable vegetation:Infective endocarditisLibman Sacks endocarditisRheumatic hea diseaseSLE  <response>: 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 Sacks endocarditis Rheumatic Fever Non bacterial Thrombotic Libman Sacks Endocarditis Infective Endocarditis Marantic Endocarditis SLE Small Small but larger than those Medium sizedsmall Large, Bulky Way, verrucous of rheumatic Flat, Verrucous,lrregular Irregular Usually Firm Friable Usually Firm; occasionally friable Friable most friableQ 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 Sacks 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. 