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Fluorine-18-Fluorodeoxyglucose PET/CT Proved Valvular Endocarditis in a Native Valve Patient
Pavithra Dhanasekaran1, Rajesh Gurunathan2, Tejaswini Chavan1
1Geriatric Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, GBR.
Insights
This study highlights the utility of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT in diagnosing native valve endocarditis (NVE) when echocardiography is inconclusive. This imaging technique aids in preventing complications in complex cases.
Area of Science:
- Cardiology
- Nuclear Medicine
- Infectious Diseases
Background:
- A 79-year-old female with multiple comorbidities presented with fever and confusion.
- Initial investigations failed to identify the source of infection, but positive blood cultures for group G Streptococcus raised suspicion for infective endocarditis (IE).
Observation:
- Transthoracic echocardiography studies were inconclusive for diagnosing native valve endocarditis (NVE).
- The patient was diagnosed with atrial fibrillation, complicating the decision for anticoagulation due to high clinical suspicion of IE.
Findings:
- Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT confirmed the diagnosis of NVE.
- 18F-FDG PET/CT played a crucial role in guiding management and preventing potential complications related to anticoagulation.
Implications:
- 18F-FDG PET/CT is a valuable tool for diagnosing challenging cases of NVE, especially when conventional methods are inconclusive.
- The findings suggest expanding the role of 18F-FDG PET/CT beyond prosthetic valve endocarditis (PVE) and device-related IE to include native valve cases.
Abstract:
A 79-year-old woman with a background history of hypertension, diabetes mellitus, hypercholesterolemia, alcoholic liver disease, and osteoporosis presented to the hospital with fever and confusion. Based on the initial investigations, it was challenging to identify the primary source of infection. Positive group G streptococcus on blood cultures raised the suspicion of uncommon infective endocarditis (IE). Two transthoracic echocardiographic studies were performed a week apart, and both were inconclusive. She was also diagnosed with atrial fibrillation, and the decision for anticoagulation became difficult as the clinical suspicion for IE was very high. Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT confirmed the diagnosis of native valve endocarditis (NVE), and the possible complication related to anticoagulation was prevented. Though 18F-FDG PET/CT is commonly used to evaluate prosthetic valve endocarditis (PVE) and IE related to cardiac devices and catheters, its role and applicability to evaluate challenging cases of NVE could be entertained.
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