Recurrent Infective Endocarditis with Mycotic Aneurysm - Imaging Modalities for the Detection of an Infective Focus.
Jennie Han1, Kenneth Okonkwo1, Nadeem Attar1
1Department of Cardiology, Royal Lancaster Infirmary, Lancaster, United Kingdom.
Summary
Nuclear imaging, including FDG-PET and WBC-SPECT, aided in diagnosing recurrent infective endocarditis (IE) and a mycotic aneurysm. These advanced techniques improve diagnostic accuracy for challenging IE cases.
Area of Science:
- Cardiology
- Nuclear Medicine
- Infectious Diseases
Background:
- Staphylococcus aureus bacteremia (SAB) and infective endocarditis (IE) are serious infections requiring timely diagnosis.
- Standard imaging like echocardiography and initial FDG-PET were inconclusive in a recurrent IE case.
Observation:
- A 58-year-old male presented with recurrent symptomatic SAB, initially treated for IE without definitive imaging findings.
- FDG-PET revealed increased uptake in the right atrial appendage, and WBC-SPECT localized the infective focus to the aortic valve IE.
- CT identified a concurrent mycotic aneurysm of the right coronary sinus.
Findings:
- Nuclear imaging modalities (FDG-PET and WBC-SPECT) successfully identified the infective focus in a complex IE case.
- The patient underwent successful surgical repair and remained symptom-free for 2 years.
- This case highlights the diagnostic value of advanced nuclear imaging in IE.
Implications:
- FDG-PET and WBC-SPECT should be considered for patients with suspected IE based on modified Duke criteria to improve diagnostic sensitivity.
- Aortic imaging is crucial in recurrent endocarditis to detect complications like mycotic aneurysms.
- Nuclear cardiovascular imaging represents an emerging tool for IE diagnosis and management.
Keywords:
EchocardiogramStaphylococcus aureus bacteremiafluorodeoxyglucose-positron emission tomographyinfective endocarditismycotic aneurysmwhite blood cell single-photon emission computerized tomographyMore Related Videos
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