Prosthetic valve endocarditis
Case submitted by Nazim Coskun
80-year-old male
Fever, malaise
Underwent aortic valve replacement (bioprosthesis) 8 months ago
Blood culture positive for Enterococcus faecalis
Selected slices showing heterogeneously increased FDG uptake around the prosthetic aortic valve (SUVmax: 5.81), persisting in the non-attenuation-corrected (NAC) images. Note the multifocal pattern of hypermetabolic foci.
Case Notes
18F-FDG PET/CT is a valuable modality for the diagnosis of selected cases with suspected prosthetic valve endocarditis, especially when echocardiography remains undiagnostic or clarification of perivalvular extension is needed. PET positivity could also have a prognostic value .
Although the sensitivity diminishes with administration of antimicrobial therapy, there is no evidence for the discontinuation of antibiotics before PET. Images must be reviewed carefully to distinguish between infection and post-surgical inflammation, particularly within three months after valve replacement. A focal/multifocal uptake pattern usually indicates infection, whereas homogeneous pattern favors non-infectious inflmmation.
18F-FDG PET/CT may be especially beneficial for patients with suspected TAVI-PVE, given the low sensitivity of echocardiography in this context.
