Question:
Which of the following has the most friable vegetation?
Which of the following has the most friable vegetation?
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Living bacteria make a soft crumbly mass that embolizes easily.
Updated On: Jun 24, 2026
- Infective endocarditis
- Libman-Sacks endocarditis
- Rheumatic heart disease
- SLE
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The Correct Option is A
Solution and Explanation
Step 1: Understand what friable means. A friable vegetation is soft, crumbly, and easily breaks off to throw emboli.
Step 2: Characterize each vegetation. Infective endocarditis, especially the acute form from Staphylococcus aureus, forms large bulky vegetations packed with fibrin, platelets, and live organisms. These are loosely held and crumble easily, so they embolize often and can destroy the valve.
Step 3: Compare the non-infective lesions. Rheumatic vegetations are small, firm, warty (verrucous) nodules sitting along the line of valve closure and are firmly attached, so they rarely embolize. Libman-Sacks endocarditis of SLE produces small sterile vegetations on either side of the valve; they are sterile and far less friable than infected ones.
Step 4: Note the overlap in options. Libman-Sacks endocarditis is the cardiac lesion of SLE, so options B and D describe the same entity; neither has friable vegetations as dramatic as infection.
Conclusion: The most friable vegetations are those of infective endocarditis. The answer is option A.
Step 2: Characterize each vegetation. Infective endocarditis, especially the acute form from Staphylococcus aureus, forms large bulky vegetations packed with fibrin, platelets, and live organisms. These are loosely held and crumble easily, so they embolize often and can destroy the valve.
Step 3: Compare the non-infective lesions. Rheumatic vegetations are small, firm, warty (verrucous) nodules sitting along the line of valve closure and are firmly attached, so they rarely embolize. Libman-Sacks endocarditis of SLE produces small sterile vegetations on either side of the valve; they are sterile and far less friable than infected ones.
Step 4: Note the overlap in options. Libman-Sacks endocarditis is the cardiac lesion of SLE, so options B and D describe the same entity; neither has friable vegetations as dramatic as infection.
Conclusion: The most friable vegetations are those of infective endocarditis. The answer is option A.
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