Nonbacterial thrombotic endocarditis (NBTE) is a pathologic state associated with autoimmune diseases and malignancy in which platelet thrombi are deposited on the heart valves in the absence of a bloodstream infection. NBTE is a diagnosis of exclusion that requires a high degree of clinical suspicion after infective endocarditis etiologies have been ruled out. The treatment of NBTE consists of systemic anticoagulation, with direct oral anticoagulants and surgery not having a clear role. The following case reviews a patient’s journey to the diagnosis of tricuspid valve nonbacterial thrombotic endocarditis in the setting of recently diagnosed metastatic lung cancer. This case adds to the growing literature on the diagnostic approach to NBTE.

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