title: Perivalvular abscess complicating infective endocarditis: complementary role of echocardiography and indium-111-labeled leukocytes.
abstract: A 49-year-old black man with hypertension-induced chronic renal failure requiring hemodialysis and a history of arteriovenous access graft infection was admitted with Staphylococcus aureus sepsis, dyspnea, and peri-incisional erythema over his arteriovenous graft fistula. Results of a transthoracic echo demonstrated aortic sclerosis and concentric left ventricular hypertrophy. Results of a whole-body In-111 white cell (WBC) scan were negative over the arteriovenous graft site; however, an intense abnormal focus of labeled WBCs was evident to the left of the sternum. A subsequent transesophageal echocardiogram showed a mixed cystic-solid calcified mass adjacent the left aortic cusp. Surgery confirmed a perivalvular abscess. As a whole-body imaging modality, the In-111 WBC scintigram indicated the true location of the infectious process responsible for the patient's sepsis. The combination of echocardiography and radiolabeled WBC imaging increases sensitivity for detection of endocarditis/perivalvular abscess. Radiolabeled WBC imaging is more efficacious for monitoring therapy because the echocardiogram often does not change with treatment of endocarditis/perivalvular abscess.
authors.affiliation: Department of Radiology, Tulane University Medical Center, New Orleans, Louisiana 70112, USA. rcampeau@tcs.tulane.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Campeau
authors.forename: C
authors.initials: C
authors.lastname: Ingram
mesh_terms: D000038:Abscess / Q000150:complications / Q000000981:diagnostic imaging*; D001021:Aortic Valve / Q000000981:diagnostic imaging; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging*; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007205:Indium Radioisotopes; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging*
chemical_list: D007205:Indium Radioisotopes