The Role of Nuclear Cardiac Imaging in Infective Endocarditis

AbstractPurpose of ReviewInfective endocarditis (IE) remains a deadly disease despite improvements in its management. Echocardiography is crucial for the diagnosis of IE; however, its value is operator-dependent and its sensitivity can decrease in the presence of valvular prosthesis. This review aims to provide an overview on the role of nuclear cardiac imaging in the diagnosis of IE.Recent FindingsAmong all nuclear cardiac imaging modalities, both radiolabeled leukocyte scintigraphy and 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) have been recently introduced in the guidelines of European Society of Cardiology (ESC) for the management of IE. The ESC guidelines included some minor criteria (mainly clinical), and two different sets of major criteria based on blood culture and imaging, respectively. The positivity of either radiolabeled leukocyte scintigraphy or [18F]FDG-PET/CT images is considered itself a major criterion to diagnose IE. However, nuclear cardiac imaging analysis may be tricky and methodological and technical aspects should be carefully considered.SummaryAvailable evidence supports the role of nuclear cardiac imaging in the diagnosis and management of IE. However, all practitioners who act within the “Endocarditis Team” should present a very high level of expertise.
Source: Current Cardiovascular Imaging Reports - Category: Radiology Source Type: research

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Publication date: Available online 9 September 2019Source: Respiratory Medicine Case ReportsAuthor(s): Mitsunori Morita, Hiromi TomiokaAbstractAn 80-year-old man was admitted to the hospital because of fever, bloody sputum and exertional dyspnea of 3 days. Laboratory tests showed anemia and increase of the C-reactive protein level. A chest computed tomography scan revealed diffuse bilateral ground-glass opacities. Bronchoalveolar lavage confirmed the clinical diagnosis of diffuse alveolar hemorrhage (DAH). After methylprednisolone pulse therapy, Enterococcus faecalis was detected in the blood cultures. A diagnosis of infec...
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
A 74-year-old man with a history of prosthetic aortic valve replacement 4 years before presentation was evaluated for a fever since the previous day. Although multiple blood cultures were positive for penicillin-susceptible Streptococcus gordonii, an oral viridans streptococcus vegetation was not detected by echocardiography, and the modified Duke criteria for infective endocarditis were not met. Despite treatment with penicillin G (18 million units daily) for 2 weeks after negative blood cultures, 4 days after the last dose blood cultures turned positive for the identical organism.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Medical images Source Type: research
A 73-year old man presented with a posterolateral ST-elevated myocardial infarction 9 months after biological aortic valve replacement for aortic valve stenosis. Invasive coronary angiography showed a filling defect across the left main coronary artery bifurcation extending into the left anterior descending artery and the ramus circumflex. Transthoracic echocardiography revealed a thickened prosthesis leaflet with signs of slight stenosis. Cardiac computed tomography angiography showed a mass on the left coronary cusp of the valve prosthesis, suggestive for vegetation or thrombus. The scan also revealed central luminal fil...
Source: Journal of Radiology Case Reports - Category: Radiology Source Type: research
ConclusionOur findings support the utility of18F-FDG-PET/CT as an adjunctive diagnostic tool especially in the evaluation of prosthetic valve-/cardiac device-related IE and for the detection of extracardiac foci in some cases. However, due to remaining limitations also of this imaging technique, a multidisciplinary clinical evaluation still remains the essential basis for the diagnostic assessment.
Source: Infection - Category: Infectious Diseases Source Type: research
Rationale: Lactococcus lactis and Pediococcus pentosaceus are rare pathogens which rarely caused infections in humans. Several cases with L. lactis endocarditis have been reported in the literature, among them few were caused by L. lactis subsp. Lactis. Opportunistic P. pentosaceus infections were rarely reported. Patient concerns: A 66-year-old man presented to our hospital due to persistent fever for 15 days. A physical checking revealed a grade II holosystolic murmur at the heart apex. A chest computed tomography (CT) scan suggested bronchitis. L. lactis subsp. lactis was identified in blood cultures. Transthoracic...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
AbstractInfective endocarditis (IE) is a life-threatening disease, establishing a diagnosis is often challenging. The aim of this prospective study was to evaluate and compare the diagnostic performance of the combined use of single photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamineoxime —labeled leukocytes (99mTc-HMPAO-SPECT/CT) with transthoracic echocardiography (TTE) in patients with suspected IE. We enrolled 40 consecutive patients (12 females, 28 males, mean age: 58.6 ± 18) with suspected IE in the years 2015–2016. All patients underwent cli...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
PMID: 30211946 [PubMed - in process]
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
AbstractInfective endocarditis (IE) is associated with significant serious adverse outcomes including death. IE usually presents with diverse clinical picture and syndromic diagnoses including heart failure, stroke, and peripheral embolization. Given variable, vague, and syndromic presentations, the diagnosis of IE may be delayed for days to weeks. Maintaining a high index of suspicion among clinicians is the key to early recognition of the disease and prompt initiation of antimicrobial therapy to prevent IE-associated mortality and morbidity. Blood culture and echocardiography remain essential tools in the diagnosis of in...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT. From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed. A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL les...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
ConclusionsThis study demonstrates that the evaluated imaging-in-endocarditis-flowchart is applicable in daily clinical practice. Echocardiography, MDCTA, and FDG-PET/CT provide relevant complementary diagnostic information, particularly in patients with intracardiac prosthetic material.
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
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