title: Septic pulmonary emboli detected by18F-FDG PET/CT in children with S. aureus catheter-related bacteremia.
abstract: OBJECTIVE
  The role of18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis of metastatic infectious foci in children with catheter-related blood stream infection has been hardly studied, although some authors have reported it benefit in the screening of metastatic foci in adult population. Septic pulmonary emboli are among the most difficult to identify, because many cases do not present pulmonary complaints or abnormal chest radiography. However, diagnosis of these foci has important therapeutic consequences. The purpose of this article is to describe the role of18F-FDG PET/CT in the diagnosis of septic pulmonary embolism in children with S. aureus catheter-related bacteremia.
  
  
  METHODS
  We report 3 children with S. aureus catheter-related bacteremia and normal chest X-ray at admission, in whom18F-FDG PET/CT led to the diagnosis of unsuspected septic pulmonary emboli, with an impact on clinical management.
  
  
  RESULTS
  All patients had hemophilia and implantable venous access ports and presented with fever and normal lung auscultation. Only 1 reported non-specific symptoms (undifferentiated left chest pain). All patients had normal chest X-ray on admission. Catheters were removed within 48 h after admission in 2 cases, and 5 days after admission in the last case, subsiding fever. In 2 children, paired blood cultures were not able to identify bacteremia. However, in all cases catheter tip and subcutaneous port cultures yielded S. aureus and PET/CT detected unsuspected pulmonary metastatic emboli.
  
  
  CONCLUSIONS
  18F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.
authors.affiliation: General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain. amendezes@yahoo.es.
authors.forename: A
authors.initials: A
authors.lastname: Méndez-Echevarria
authors.affiliation: Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Coronado-Poggio
authors.affiliation: General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Baquero-Artigao
authors.affiliation: General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Del Rosal
authors.affiliation: Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Rodado-Marina
authors.affiliation: General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Calvo
authors.affiliation: Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Domínguez-Gadea
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D019788:Fluorodeoxyglucose F18 / Q000737:chemistry; D006801:Humans; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000382:microbiology; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000502:physiology*
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; Bacteremia; Catheter; Metastatic infection; Staphylococcus aureus