Author + information
- Nidaa Mikail, MD∗,
- Khadija Benali, MD∗,
- Phalla Ou, MD, PhD†,
- Jerome Slama, MD∗,
- Fabien Hyafil, MD, PhD∗,
- Dominique Le Guludec, MD, PhD∗ and
- Francois Rouzet, MD, PhD∗∗ ()
- ∗Department of Nuclear Medicine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- †Department of Radiology, Bichat-Claude Bernard Hospital, AP-HP, France
- ↵∗Reprint requests and correspondence:
Dr. Francois Rouzet, Service de Médecine Nucléaire, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France.
Although they are rare, mycotic aneurysms (MAs) are a potentially severe complication of infective endocarditis (IE) that usually requires a specific therapy. They are most frequently found intracranially, but other locations are possible and are probably underestimated. In addition, as a minor criterion of the modified Duke-Li classification, detection of MAs affects the diagnostic certainty of IE. There is increasing evidence of the usefulness of fluorodeoxyglucose-F 18 positron emission tomography/computed tomography (18-FDG PET/CT) in the management of IE, both for diagnosis of valve infection and detection of septic emboli (1,2). As such, it may be considered as a second-line method, complementary to echocardiography. The routine oncology-derived field of acquisition from the skull base to upper thighs can lead to underestimation of the true extent of the disease. Accordingly, we performed true whole-body acquisitions (from vertex to toes) in a series of approximately 200 patients referred for suspicion of IE and who had inconclusive transthoracic and transesophageal (whenever possible) echocardiographies related to atypical findings in patients with a high likelihood of endocarditis, or altered echogenicity in patients with prosthetic valves or intracardiac material. In the present paper, we highlight the recurrent finding (approximately 5 of 100 patients) of MAs in the branches of femoral arteries, in relation to the extension of the field of acquisition of FDG PET/CT.
Of 5 patients presented here, 4 underwent CT angiography and/or arteriography (Patients #1 to #4, Figures 1 to 4⇓⇓⇓), which confirmed the diagnosis of MA. The remaining patient experienced sudden death before further investigations (Patient #5, Figure 5), with a diagnostic hypothesis of cerebral hemorrhage.
In the setting of suspected IE, 18F-FDG PET/CT allows detection of asymptomatic MAs, with a potential impact on diagnostic certainty and therapeutic management. We found that they were most likely located in the arteries of the lower limbs, supporting the acquisition of true whole-body scans. On the basis of these very preliminary findings, we consider that true whole-body 18F-FDG PET/CT should be part of the routine examination in the setting of IE, until large-scale studies can determine the subset of patients who would benefit the most from this type of scan.
The authors have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
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