Showers Head to Toe: Imaging of Infective Endocarditis

Infective endocarditis is a serious infection of the heart's inner lining and valves, with a high risk of systemic complications due to septic emboli. These complications can affect various organs, including the brain, lungs, abdomen, vasculature, and musculoskeletal system. Diagnosing infective endocarditis can be challenging, often with underappreciated complications that significantly impact treatment decisions, including the potential need for surgery. While echocardiography remains the primary diagnostic imaging modality, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) can be crucial for identifying and characterizing complications. This comprehensive review emphasizes the key role of radiologists in identifying secondary features of infective endocarditis, which can manifest in various organs. It explores the diverse presentations of infective endocarditis through patient cases, highlighting the strengths of different imaging modalities-echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-in diagnosing cardiovascular, pulmonary, and systemic complications. Understanding the imaging spectrum of infective endocarditis, is essential to enhancing diagnostic accuracy, guiding treatment decisions, and improving patient outcomes.