title: Aortic root infection in a prosthetic valve demonstrated by gallium-67 citrate SPECT.
abstract: A 70-year-old man presented with 6 weeks of worsening low back pain, fever, sweating, and weight loss with known severe lumbosacral osteoarthritis. His history included CABG in 1992, porcine aortic valve replacement, and permanent pacemaker implantation in 2002. CT of the chest, abdomen, and pelvis did not demonstrate a cause for the symptoms. Blood cultures grew penicillin-sensitive enterococcus and he was referred for evaluation of possible osteodiskitis or epidural abscess. Gallium planar imaging demonstrated increased activity in the lumbar spine, suspicious for the presence of infection, and activity was noted in the mid mediastinum as well. SPECT clearly showed increased Ga-67 activity in the region of the aortic root, suspicious for infection. A perivalvular aortic root abscess was subsequently demonstrated by transesophageal echo. This case illustrates the value of Ga-67 chest SPECT in patients with prosthetic valves for detection of endocarditis.
authors.affiliation: Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: L E J
authors.initials: LE
authors.lastname: Thomson
authors.forename: M P
authors.initials: MP
authors.lastname: Goodman
authors.forename: T Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: R
authors.initials: R
authors.lastname: Feldman
authors.forename: N A
authors.initials: NA
authors.lastname: Buchbinder
authors.forename: A
authors.initials: A
authors.lastname: Waxman
authors.forename: A
authors.initials: A
authors.lastname: D'Agnolo
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001025:Aortitis / Q000000981:diagnostic imaging* / Q000209:etiology; D002951:Citrates; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000209:etiology; D005708:Gallium; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D002951:Citrates; D019275:Radiopharmaceuticals; D005708:Gallium; C103850:gallium citrate