Aortic Root Abscess Clearly Shown on 111In-Leukocyte Scan But Less Obvious on Transesophageal Echocardiogram

A 79-year-old man with history of aortic stenosis, status post bioprosthetic aortic valve replacement, episodes of bacteremia, and endocarditis presented to hospital with fever. Clinical assessment led to suspicion of possible endocarditis. Initial interpretation of transesophageal echocardiogram was inconclusive without vegetation in mitral/aortic valve. An In-leukocyte scan demonstrated increased uptake in the area of aortic valve, suggestive of infection. Further review of the transesophageal echocardiogram showed signs of annular abscess. This case highlights that combination of echocardiography with white blood cell imaging increases the sensitivity to detect endocarditis/perivalvular abscess.