title: Molecular imaging in Libman-Sacks endocarditis.
abstract: We present a 54-year-old woman with systemic lupus erythematosus (SLE), fever, pericardial effusion and a mitral valve vegetation. (18)F-Fluorodesoxyglucose positron emission tomography CT ((18)F-FDG-PET-CT) showed very high accumulation of the isotope at the mitral valve. The patient underwent cardiothoracic surgery and pathologic examinations showed characteristic morphology of Libman-Sacks vegetations. All microbiological examinations including blood cultures, microscopy, culture and 16s PCR of the valve were negative and the diagnosis of Libman-Sacks endocarditis was convincing. It is difficult to distinguish Libman-Sacks endocarditis from culture-negative infective endocarditis (IE). Molecular imaging techniques are being used increasingly in cases of suspected IE but no studies have previously reported the use in patients with Libman-Sacks endocarditis. In the present case, (18)F-FDG-PET-CT clearly demonstrated the increased glucose uptake caused by infiltrating white blood cells in the ongoing inflammatory process at the mitral valve. In conclusion, (18)F-FDG-PET-CT cannot be used to distinguish between IE and non-infective Libman-Sacks vegetations.
authors.affiliation: From the 1 Department of Cardiology.
authors.forename: Anders
authors.initials: A
authors.lastname: Dahl
authors.forename: Bente K
authors.initials: BK
authors.lastname: Schaadt
authors.forename: Eric
authors.initials: E
authors.lastname: Santoni-Rugiu
authors.forename: Niels E
authors.initials: NE
authors.lastname: Bruun
mesh_terms: D004696:Endocarditis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008180:Lupus Erythematosus, Systemic; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D057054:Molecular Imaging / Q000379:methods*; D011877:Radionuclide Imaging
keywords: Endocarditis; Libman-Sacks; culture-negative endocarditis; molecular imaging