Dados do Trabalho

Título

An indication for PET-CT: Atypical seeding in infective endocarditis

Descrição sucinta do(s) objetivo(s)

Infectious Endocarditis(IE) has an updated global incidence of 13.8 episodes/100.000 persons-year and is associated with a considerable morbidity and mortality. ACR 2021 recommends considering the FDG-PET/CT on suspect or well known cases of IE to detect disseminated disease, periprosthetic abscess and maximize the chance of finding intracardiac infection.

This paperwork is about a patient with prosthetic valve IE, that presents a rare septic embolization as a complication. The use of PET/CT plays an important role in describing the original infection and the places where the embolic seeding has reached, in this case, a rare manifestation in lower extremities. In addition, there is an anatomopathology description to improve the comprehension and physiology of the image.

História clínica

Male patient, 39 years old, clinical history of aortic prosthetic valve, goes to the emergency room presenting 48 hours of myalgias, fever, fatigue, headache and multiple hematomas with generalized distribution. Blood tests show increased inflammatory parameters and positive blood cultures to S. Aureus. The FDG-PET/CT describes an aortic ring abscess and systemic septic embolism to different muscle levels in both lower extremities and brain; that could be associated with infectious endocarditis diagnosis. As a treatment, triassociated antibiotic therapy is initiated and gets mechanical valve replacement.

Discussão e diagnóstico

Systemic embolization as an IE complication implies worst clinical prognosis and occurs in 22-50% of cases. Central nervous system is the most frequently affected place, though the musculoskeletal system is rarely affected, so it implies a challenge at the moment to find and describe the lesion, where FDG-PET/CT has a 100% sensibility and 91% specificity.

Use of FDG-PET/CT helps to reduce suspicious IE rate in patients with negative blood cultures and improves detection of extracardiac emboli and metastatic infections, it's also demonstrated the use for follow-up on clinical response and antibiotic response.

Conclusões

The utility of FDG-PET/CT on the evaluation of IE remarks on the study of systemic embolization, especially on less frequent places such as musculoskeletal embolia. It is important to establish that the correct use can improve the detection of extracardiac infection and the early diagnosis of peripheral embolism, which has clinical implications on the treatment and corresponding follow-up.

Palavras Chave

FDG-PET/CT; Septic Embolism; infective endocarditis

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