title: Combined computed tomography and fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic valve endocarditis: a case series.
abstract: BACKGROUND
  The diagnosis of prosthetic valve endocarditis is challenging. The gold standard for prosthetic valve endocarditis diagnosis is trans-esophageal echocardiography. However, trans-esophageal echocardiography may result in negative findings or yield images difficult to differentiate from thrombus in patients with prosthetic valve endocarditis. Combined computed tomography and fluorodeoxyglucose positron emission tomography is a potentially promising diagnostic tool for several infectious conditions and it has also been employed in patients with prosthetic valve endocarditis but data are still scant.
  
  
  METHODS
  We reviewed the charts of 6 patients with prosthetic aortic valves evaluated for suspicion of prosthetic valve endocarditis, at two different hospital, over a 3-year period. We found 3 patients with early-onset PVE cases and blood cultures yielding Pseudomonas aeruginosa, Staphylococcus epidermidis and Staphylococcus lugdunensis, respectively; and 3 late-onset cases in the remaining 3 patients with isolation in the blood of Streptococcus bovis, Candida albicans and P. aeruginosa, respectively. Initial trans-esophageal echocardiography was negative in all the patients, while fluorodeoxyglucose positron emission tomography showed images suspicious for prosthetic valve endocarditis. In 4 out of 6 patients valve replacement was done with histology confirming the prosthetic valve endocarditis diagnosis. After an adequate course of antibiotic therapy fluorodeoxyglucose positron emission tomography showed resolution of prosthetic valve endocarditis in all the patients.
  
  
  CONCLUSIONS
  Our experience confirms the potential role of fluoroseoxyglucose positron emission tomography in the diagnosis and follow-up of prosthetic valve endocarditis.
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoletti
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fasulo
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.forename: Francesco
authors.initials: F
authors.lastname: Cristini
authors.forename: Rachele
authors.initials: R
authors.lastname: Bonfiglioli
authors.forename: Luigi
authors.initials: L
authors.lastname: Raumer
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanfilippo
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Scotton
authors.forename: Maddalena
authors.initials: M
authors.lastname: Graziosi
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico S, Orsola Malpighi, Alma Mater Studiorum Università di Bologna, Bologna, Italy. pierluigi.viale@unibo.it.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology; D002177:Candidiasis / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy; D004696:Endocarditis / Q000175:diagnosis / Q000628:therapy; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D005188:False Negative Reactions; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D019275:Radiopharmaceuticals; D012086:Reoperation; D014057:Tomography, X-Ray Computed
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18