Tip of the iceberg: extracardiac CT findings in infective endocarditis

Area of Science:

• Radiology
• Cardiology
• Infectious Diseases

Background:

• Infective endocarditis (IE) presents with diverse symptoms, often mimicking other conditions, leading to diagnostic challenges.
• High-risk factors for IE include intravenous drug use, prior cardiac surgery, and indwelling cardiac devices.
• The modified Duke criteria are standard but have limitations in certain IE cases.

Purpose of the Study:

• To review common extracardiac complications of infective endocarditis (IE).
• To highlight characteristic computed tomography (CT) findings of IE complications across various body regions.
• To emphasize the role of emergency room radiologists in identifying unsuspected IE through CT.

Main Methods:

• Review of literature focusing on CT findings of IE extracardiac complications.
• Analysis of imaging features in the chest, abdomen, pelvis, and brain associated with IE.
• Discussion of diagnostic challenges and the utility of CT in early IE detection.

Main Results:

• Common extracardiac complications of IE visualized on CT include embolic events, abscesses, and mycotic aneurysms.
• CT can reveal secondary signs of IE in the chest, abdomen, pelvis, and brain, even when IE is not initially suspected.
• Radiologists can facilitate prompt IE management by recognizing these CT findings.

Conclusions:

• CT plays a crucial role in identifying extracardiac manifestations of infective endocarditis (IE).
• Early recognition of IE complications on CT by emergency room radiologists can expedite diagnosis and treatment.
• Echocardiography remains essential for confirming IE when suspected based on CT findings.