Infective endocarditis: Echocardiographic imaging and new imaging modalities

Diagnosing Endocarditis: Get the Picture?!

“…negative yet there exists high suspicion for IE, a repeat TEE is recommended. 5 While TTE may be useful in the settings of native left-sided valve IE with excellent echogenicity, tricuspid valve IE, and/or detection of anterior aortic abscess (especially prosthetic valve IE), it remains inferior to TEE, especially for detection of vegetations and size measurements, which have a major impact on embolism risk and indication for early surgery (prosthetic valve/intracardiac device).…”

“…Despite TEE's superiority to TTE, its sensitivity/specificity for suspected native valve endocarditis is only 90% -100% / 90%. 5 The low specificity of TEE relates to distinguishing valvular vegetation from other intracardiac masses and from ultrasound artifacts. Echocardiographic findings that may be mistaken for vegetation include papillary fibroelastoma, myxomatous mitral valve disease, nonbacterial thrombotic endocarditis, thrombus, and/or normal valve variants (Lambl excrescence).…”

“…While the roles of three-dimensional (3D) echocardiography and intracardiac echocardiography (ICE) are increasing, they still are regarded as supplements to standard echocardiography in most cases. 5,7 Not surprisingly, numerous guidelines have been published over the years recommending a wide variety of approaches in the timing and mode of TTE/TEE assessment in patients with suspected or real IE. 4 Thus, to enhance our ability to definitively diagnose/treat IE, new imaging modalities are now supplementing information from echocardiography, including computed tomography (CT), magnetic resonance imaging (MRI), and nuclear molecular imaging.…”

“…4 Thus, to enhance our ability to definitively diagnose/treat IE, new imaging modalities are now supplementing information from echocardiography, including computed tomography (CT), magnetic resonance imaging (MRI), and nuclear molecular imaging. 5,8 Cardiac CT (CCT) has gained traction as an adjunct to echocardiography, when echo is unable to offer diagnostic clarity, or if invasive testing is undesirable. CT coronary angiography (CTCA) is used to evaluate coronary artery disease, coronary artery stenosis, or coronary artery anatomy prior to cardiac surgery, in some cases in place of invasive angiography.…”

Extended spectrum beta lactamase producing Escherichia coli eustachian valve infective endocarditis

“…In a retrospective analysis by Biswas A et al, 27 high risk patients for IE that underwent TTE and TEE examinations were studied and only 29.6% of these patients were found to have vegetation on TTE. This study recommended TEE as the initial diagnostic tool for high risk patients without need for TTE [ 9 ]. In our case, the patient had high risk features and therefore warranted immediate TEE to rule out IE which confirmed vegetation on the eustachian valve, likely from E. coli ESBL, given the positive blood culture tests.…”