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Cardiac multidetector computed tomography in infective endocarditis: a pictorial essay.

Grob A, Thuny F, Villacampa C, Flavian A, Gaubert JY, Raoult D, Casalta JP, Habib G, Moulin G, Jacquier A - Insights Imaging (2014)

Bottom Line: Extra-cardiac location could involve all organs.MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive.MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously. • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Service de Radiologie Adultes, Centre Hospitalier Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.

ABSTRACT

Objectives: The goals of this pictorial essay are: (1) to set out a multislice computed tomography (MSCT) imaging protocol to assess infective endocarditis (IE); (2) to give an MSCT overview of valvular and peri-valvular involvement during IE; (3) to give a CT overview of septic embolism and infectious pseudoaneurysms during IE.

Methods: MSCT acquisition protocols to assess IE are performed in two different phases: the first acquisition, under electrocardiography (ECG) gating, covers the cardiac structures during first-pass iodine injection; the second acquisition covers the thorax, abdomen, pelvic and cerebral regions.

Results: Valvular and peri-valvular lesions during IE are: vegetation-a hypodense, homogeneous, irregular mass on a valve or endocardial structure; perforation-a defect in the leaflet; valvular aneurysm-loss of the homogenous curvature of the leaflet; valvular thickening; peri-valvular abscess; pseudoaneurysm; fistula and disinsertion of a prosthetic valve. Extra-cardiac location could involve all organs.

Conclusions: MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive. MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously.

Main messages: • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

No MeSH data available.


Related in: MedlinePlus

Non-contrast cerebral CT shows a spontaneous hyperdensity in the basal cistern due to subarachnoid haemorrhage (black arrow)
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Fig10: Non-contrast cerebral CT shows a spontaneous hyperdensity in the basal cistern due to subarachnoid haemorrhage (black arrow)

Mentions: In most series neurological events develop in 20-40 % of all patients with IE [24]. These are associated with a high mortality rate. Cerebral CT can be useful to detect neurological complications such as ischaemic strokes, cerebral haemorrhage and brain abscesses. Ischaemic stroke is a common complication of IE and usually presents as a hypodense area at the grey-white junction; these areas are often multiple. IV contrast can enhance the lesion, which suggests a breakdown of the blood brain barrier (Fig. 9). Intracranial haemorrhage appears as a spontaneous hyperdensity in the subarachnoid space on a non-enhanced CT (Fig. 10). Angio-CT and/or magnetic resonance imaging (MRI) should be performed to rule out mycotic aneurysms, but conventional angiography remains the gold standard. Brain abscess is a rare complication of IE. Contrast-enhanced CT shows a mixed density lesion with peripheral enhancement surrounded by oedema (Fig. 11). It is important to emphasise that MRI is more valuable in the identification of neurological complications.Fig. 9


Cardiac multidetector computed tomography in infective endocarditis: a pictorial essay.

Grob A, Thuny F, Villacampa C, Flavian A, Gaubert JY, Raoult D, Casalta JP, Habib G, Moulin G, Jacquier A - Insights Imaging (2014)

Non-contrast cerebral CT shows a spontaneous hyperdensity in the basal cistern due to subarachnoid haemorrhage (black arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195843&req=5

Fig10: Non-contrast cerebral CT shows a spontaneous hyperdensity in the basal cistern due to subarachnoid haemorrhage (black arrow)
Mentions: In most series neurological events develop in 20-40 % of all patients with IE [24]. These are associated with a high mortality rate. Cerebral CT can be useful to detect neurological complications such as ischaemic strokes, cerebral haemorrhage and brain abscesses. Ischaemic stroke is a common complication of IE and usually presents as a hypodense area at the grey-white junction; these areas are often multiple. IV contrast can enhance the lesion, which suggests a breakdown of the blood brain barrier (Fig. 9). Intracranial haemorrhage appears as a spontaneous hyperdensity in the subarachnoid space on a non-enhanced CT (Fig. 10). Angio-CT and/or magnetic resonance imaging (MRI) should be performed to rule out mycotic aneurysms, but conventional angiography remains the gold standard. Brain abscess is a rare complication of IE. Contrast-enhanced CT shows a mixed density lesion with peripheral enhancement surrounded by oedema (Fig. 11). It is important to emphasise that MRI is more valuable in the identification of neurological complications.Fig. 9

Bottom Line: Extra-cardiac location could involve all organs.MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive.MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously. • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Service de Radiologie Adultes, Centre Hospitalier Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.

ABSTRACT

Objectives: The goals of this pictorial essay are: (1) to set out a multislice computed tomography (MSCT) imaging protocol to assess infective endocarditis (IE); (2) to give an MSCT overview of valvular and peri-valvular involvement during IE; (3) to give a CT overview of septic embolism and infectious pseudoaneurysms during IE.

Methods: MSCT acquisition protocols to assess IE are performed in two different phases: the first acquisition, under electrocardiography (ECG) gating, covers the cardiac structures during first-pass iodine injection; the second acquisition covers the thorax, abdomen, pelvic and cerebral regions.

Results: Valvular and peri-valvular lesions during IE are: vegetation-a hypodense, homogeneous, irregular mass on a valve or endocardial structure; perforation-a defect in the leaflet; valvular aneurysm-loss of the homogenous curvature of the leaflet; valvular thickening; peri-valvular abscess; pseudoaneurysm; fistula and disinsertion of a prosthetic valve. Extra-cardiac location could involve all organs.

Conclusions: MSCT can be considered as a useful complement in visualising the cardiac lesions of IE if echocardiography is inconclusive. MSCT is the only imaging modality that provides assessment of valvular and peri-valvular involvement, extra-cardiac lesions, and non-invasive evaluation of the coronary artery anatomy, simultaneously.

Main messages: • MSCT provides assessment of coronary anatomy, cardiac and extra-cardiac lesions. • MSCT represents an alternative to echocardiography during IE. • Surgical valve replacement is usually required if vegetation is >10 mm. • Peri-valvular extension (abscesses, pseudoaneurysm and fistulae) required surgical treatment.

No MeSH data available.


Related in: MedlinePlus