Libman-Sacks endocarditis is a form of non-bacterial thrombotic endocarditis seen in patients with systemic lupus erythematosus. It consists of sterile vegetations composed of immune complexes and mononuclear cells enmeshed in fibrin thrombi usually on the ventricular aspects of mitral and aortic valve leaflets. The image shows a stenotic mitral valve with dilatation of the left atrium, vascularized scars of the mitral valve leaflets near their line of closure, and scarred thickened chordae. The patient was a 55 y/o female with a long-standing history of SLE. Image copyright: pathorama.ch.