Infectious pseudoaneurysms suspected at echocardiography: electron-beam CT findings

Area of Science:

• Cardiovascular Imaging
• Infectious Diseases
• Radiology

Background:

• Perivalvular pseudoaneurysms are serious complications of endocarditis.
• Echocardiography is the primary imaging modality but has limitations in visualizing these lesions.
• Electron-beam CT (EBCT) offers high-resolution imaging for complex cardiovascular conditions.

Purpose of the Study:

• To evaluate EBCT findings in patients with suspected perivalvular pseudoaneurysms.
• To compare EBCT findings with echocardiography in endocarditis patients.
• To assess EBCT's utility in detecting and characterizing pseudoaneurysms.

Main Methods:

• Retrospective review of 17 patients with suspected perivalvular infectious pseudoaneurysm on echocardiography.
• Patients underwent electron-beam CT (EBCT).
• EBCT findings were compared with echocardiographic, surgical, and autopsy data.

Main Results:

• EBCT identified abnormal cavities (pseudoaneurysms) in all patients.
• EBCT revealed a higher mean size (3.5 cm vs 2.9 cm) and number (21 vs 13) of pseudoaneurysms compared to echocardiography.
• EBCT detected additional pseudoaneurysms not seen on echocardiography in 47% of patients and identified associated complications like mediastinitis and coronary arterial involvement.

Conclusions:

• Electron-beam CT (EBCT) accurately depicts thoracic infectious pseudoaneurysms.
• EBCT provides superior detection of lesion size, number, and extent compared to echocardiography.
• EBCT is a valuable adjunct to echocardiography for diagnosing perivalvular pseudoaneurysms and aiding preoperative planning.