Dataset Information

The pivotal role of cardiac computed tomography angiogram and ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

ABSTRACT:

Background

Infective endocarditis (IE) poses many clinical and diagnostic challenges. Echocardiography is regarded as the imaging modality of choice for the diagnosis of IE, and plays a key role in both the diagnosis and management of endocarditis. We report on a case in which one could have overlooked an endocarditis of a pulmonary homograft if one had relied on echocardiography alone.

Case summary

A 38-year-old man presented with intermittent fever and fatigue for 1 month. He had undergone a Ross procedure for a bicuspid aortic valve stenosis at the age of 17?years. At the age of 36?years a valve-sparing aortic root replacement was performed because of aortic root dilatation. Besides a systolic murmur 3/6 noted at the left sternal border, physical examination was normal. Multiple blood cultures grew Streptococcus mitis. Both transthoracic and transoesophageal echocardiogram could not detect any signs of endocarditis. As endocarditis can be overlooked due to reverberations and acoustic shadowing, we performed ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) and cardiac computed tomography angiogram (cardiac CTA). Both imaging modalities showed large vegetations attached to the pulmonary homograft.

Discussion

Endocarditis poses diagnostic challenges. While echocardiography is the cornerstone of imaging, one may overlook a pulmonary homograft endocarditis due to reverberations and acoustic shadowing. Therefore, if clinical suspicion of endocarditis is strong, one should consider additional imaging by means of cardiac CTA and/or ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography imaging to assess valves in pulmonary position, especially in those whom have had prior surgical intervention at this location.

SUBMITTER: El Barzouhi A

PROVIDER: S-EPMC6439376 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

The pivotal role of cardiac computed tomography angiogram and <sup>18</sup>F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

El Barzouhi Abdelilah A Tanis Wilco W van Gelder Rogier E RE Vriend Joris W J JWJ

European heart journal. Case reports 20190108 1

<h4>Background</h4>Infective endocarditis (IE) poses many clinical and diagnostic challenges. Echocardiography is regarded as the imaging modality of choice for the diagnosis of IE, and plays a key role in both the diagnosis and management of endocarditis. We report on a case in which one could have overlooked an endocarditis of a pulmonary homograft if one had relied on echocardiography alone.<h4>Case summary</h4>A 38-year-old man presented with intermittent fever and fatigue for 1 month. He ha ...[more]

PMID: 31020241

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Project description:Positron emission tomography (PET) visualizes increased cellular [F]fluorodeoxyglucose ([F]FDG) uptake. Pulmonary hypertension (PH) is conceived of a proliferative disease of the lung vessels. Increased glucose uptake can be quantified as pulmonary [F]FDG uptake via PET imaging. Because the angioproliferative mechanisms in PH are still in need of further description, the aim of the present study was to investigate whether [F]FDG PET/CT imaging can elucidate these pathophysiologic mechanisms in different etiologies of PH.Patients (n?=?109) with end-stage pulmonary disease being evaluated for lung transplant were included in this observational study. Mean standardized uptake value (SUVmean) of predefined regions of interest in lung parenchyma (LP), left (LV), and right ventricle (RV) of the heart, and SUVmax in pulmonary artery (PA) were determined and normalized to liver uptake. These SUV ratios (SUVRs) were compared with results from right heart catheterization (mean pulmonary artery pressure [mPAP], pulmonary vascular resistance [PVR]), and serum N-terminal pro-brain natriuretic peptide. Group comparisons were performed and Pearson correlation coefficients (r) were calculated.The [F]FDG uptake ratios in LP, RV, RV/LV, and PA, but not in LV, were found to be significantly higher in both patients with mPAP ?25?mm Hg (P?=?0.013, P?=?0.006, P?=?0.049, P?=?0.002, P?=?0.68, respectively) and with PVR ?480?dyn·s/cm (P?<?0.001, P?=?0.045, P?<?0.001, P?<?0.001, P?=?0.26, respectively). The [F]FDG uptake in these regions positively correlated also with mPAP, PVR, and N-terminal pro-brain natriuretic peptide. The SUVR of PA positively correlated with the SUVR of LP and RV (r?=?0.55, r?=?0.42, respectively).Pulmonary and cardiac [F]FDG uptake in PET imaging positively correlated with the presence and severity of PH in patients with end-stage pulmonary disease. Increased glucose metabolism in the central PAs seems to play a certain role in terms of severity of PH. These results suggest that [F]FDG-PET imaging can help understand the pathophysiology of PH as a proliferative pulmonary disease.

Dataset Information

The pivotal role of cardiac computed tomography angiogram and ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

Background

Case summary

Discussion

Publications

The pivotal role of cardiac computed tomography angiogram and <sup>18</sup>F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

The pivotal role of cardiac computed tomography angiogram and 18F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

Background

Case summary

Discussion

Publications

The pivotal role of cardiac computed tomography angiogram and <sup>18</sup>F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

The pivotal role of cardiac computed tomography angiogram and ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.