Cardiac 18F-FDG PET/CT With Heparin Detects Infective Vegetation in a Patient With Mechanical Valve Replacement

Klaipetch, Alisa; Manabe, Osamu; Oyama‐Manabe, Noriko; Chiba, Satoru; Naya, Masanao; Yamada, Shiro; Hirata, Kenji; Tsutsui, Hiroyuki; Tamaki, Nagara

doi:10.1097/rlu.0b013e318251e3f4

Cited by 7 publications

(1 citation statement)

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“…The patient's history of repeated cardiac surgery might have been a main reason for the negative results of echocardiography. Utility of FDG-PET for the evaluation of IE has been reported; [1][2][3] however, utility of contrast-enhanced CT has not been established. The present case shows that a contrast-enhanced CT scan of the heart may be an alternative method for uncovering infective vegetation, especially in patients with previous cardiac surgery.…”

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confidence: 99%

CT visualising infective vegetation

et al. 2014

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DESCRIPTIONA 34-year-old man with a history of five cardiac operations including an operation for construction of a right ventricular outflow tract (RVOT) with a homograft due to extreme tetralogy of Fallot suffered from persistent fever. With positive blood culture (methicillin-sensitive Staphylococcus aureus) and multiple septic pulmonary emboli shown by CT, right-sided infective endocarditis (IE) was suspected. Transthoracic and transoesophageal echocardiograms were subsequently obtained but did not depict any pathogenic lesions. However, a contrast-enhanced CT scan of the heart successfully revealed a defect of contrast media at the RVOT (figure 1A), which was not seen in a previous CT scan. Fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated a high uptake at the corresponding site (figure 1B). Under a diagnosis of right-sided IE, antibiotic therapy was initiated. After 8 weeks, although the patient's condition improved and serum inflammatory markers were all within normal ranges, the lesion had not disappeared ( figure 1C) and cardiac surgery was eventually performed. It was confirmed that the vegetation remained and replacement of the RVOT was performed.Echocardiography is a gold standard method to visualise infective vegetation, but it failed in this case. The patient's history of repeated cardiac surgery might have been a main reason for the negative results of echocardiography. Utility of FDG-PET for the evaluation of IE has been reported; 1-3 however, utility of contrast-enhanced CT has not been established. The present case shows that a contrast-enhanced CT scan of the heart may be an alternative method for uncovering infective vegetation, especially in patients with previous cardiac surgery.

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Section: Descriptionmentioning

confidence: 99%