Case Report: 18F-FDG PET-CT for Diagnosing Prosthetic Device-Related Infection in an Infant With CHD

Abstract

Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drainage and 6 weeks of antibiotic therapy improved her condition, but bacteremia flared up on postoperative day 56. Despite a long course of antibiotic therapy, she had two more recurrences of bacteremia with the detection of P. aeruginosa. Echocardiography and chest contrast CT showed no evidence of vegetation and mediastinitis. On postoperative day 115, 18F-FDG PET-CT revealed an accumulation on the RV-PA conduit (SUV max 3.4). Finally, she developed an infectious ventricular pseudo-aneurysm on postoperative day 129 and underwent aneurysm removal and RV-PA conduit replacement on postoperative day 136. Our case showed the importance of 18F-FDG PET-CT for diagnosing specific localization of prosthetic device-related infection which is hard to detect using other imaging techniques. It can be a useful diagnostic tool for infantile patients with CHD with cardiac prosthetic devices and improve subsequent clinical treatments.

Comparison of organ and effective dose estimations from different Monte Carlo simulation‐based software methods in infant CT and comparison with direct phantom measurements

“…Although whole‐body CT acquisitions in infants are currently limited to a few applications, 41 , 42 , 43 the CTDI vol normalized data presented in this study can easily be implemented to assess the doses to primary beam organs most at risk during infant examinations that implement different scan coverages. This may be particularly useful for clinicians who may not have access to CT dosimetry software.…”

“…Doses to skeletal tissues and effective doses were not evaluated in that study. 24 Although whole-body CT acquisitions in infants are currently limited to a few applications, [41][42][43] the CTDI vol normalized data presented in this study can easily be implemented to assess the doses to primary beam organs most at risk during infant examinations that…”

Pediatric Infective Endocarditis: A Literature Review

“…These multimodal imaging techniques are very versatile, since they allow a differential diagnosis with other infective processes, confirm the diagnosis in cases with inconclusive echocardiographic techniques, and therefore, have a great impact on subsequent antimicrobial therapy [ 61 ]. The sensitivity is close to 100% and its reliability has also been demonstrated in children [ 56 , 57 , 61 ]. PET-CT is very useful in detecting septic emboli and also in areas with little clinical expression such as the lungs or the spleen [ 55 ].…”

“…Advanced cardiovascular imaging modalities such as cardiac magnetic resonance imaging, computed tomography angiography, or positron emission tomography in combination with computed tomography (PET-CT) have gained interest in recent years, due to the lower sensitivity of echocardiography for the diagnosis of IE in children with corrected congenital heart disease, especially those with mechanical prosthetic valves, conduits, stents, or ventricular assist devices [ 55 , 56 , 57 ]. High-resolution multislice gated cardiac CT has a high added value for diagnosing paravalvular complications such as abscess, but there is scarce evidence for the diagnosis of infective endocarditis in children [ 34 ].…”

Nuclear Imaging in Pediatric Cardiology: Principles and Applications

“…Although these recommendations were based on studies including left heart valve prostheses, recent works has validated the performance of PET/CT for right heart prostheses and conduits, implanted pacing devices and VADs in children and adults ( 99 – 104 ). As for all nuclear imaging techniques, there is no age limit to perform a cardiac 18F-FDG PET/CT for suspected PVE, with the youngest patient described in the literature being 1 year old ( 105 ). So far, no study has evaluated 18F-FDG PET/CT imaging for diagnosis of PVE in a specific pediatric population but there is no reason to believe that the performance would differ in the pediatric subgroup, when the appropriate protocols can be applied ( 99 ).…”