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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

Results of echocardiography and MSCT studies in a case of aortic valve IE. The TEE study, 120-degree long-axis view (a) and MSCT acquisition with MPR reconstructions in the LVOT view (b), show a huge vegetation on the aortic valve (white arrows). MSCT acquisitions with MPR in the LVOT view (c) on the level of aortic annulus (d) are displayed in a narrowed imaging window, suitable for analysing para-valvular tissue, and show an abscess located in the anterior part of the aortic root (black arrows)
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Fig4: Results of echocardiography and MSCT studies in a case of aortic valve IE. The TEE study, 120-degree long-axis view (a) and MSCT acquisition with MPR reconstructions in the LVOT view (b), show a huge vegetation on the aortic valve (white arrows). MSCT acquisitions with MPR in the LVOT view (c) on the level of aortic annulus (d) are displayed in a narrowed imaging window, suitable for analysing para-valvular tissue, and show an abscess located in the anterior part of the aortic root (black arrows)

Mentions: An abscess is a closed purulent collection. It is defined on echocardiography as a thickened, non-homogenous peri-valvular area with an echo-dense or echo-lucent appearance [1]. On MSCT, a peri-valvular abscess appears as a peri-valvular collection of liquid density surrounded by a thick layer of inflammatory tissue enhanced by injection of contrast medium (Fig. 4). Abscesses can infiltrate the structures surrounding the valve such as the LV myocardium or the inter-atrial septum. Abscesses are more frequently observed on the aortic valve and in prosthetic valve IE [6].Fig. 4


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)

Results of echocardiography and MSCT studies in a case of aortic valve IE. The TEE study, 120-degree long-axis view (a) and MSCT acquisition with MPR reconstructions in the LVOT view (b), show a huge vegetation on the aortic valve (white arrows). MSCT acquisitions with MPR in the LVOT view (c) on the level of aortic annulus (d) are displayed in a narrowed imaging window, suitable for analysing para-valvular tissue, and show an abscess located in the anterior part of the aortic root (black arrows)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig4: Results of echocardiography and MSCT studies in a case of aortic valve IE. The TEE study, 120-degree long-axis view (a) and MSCT acquisition with MPR reconstructions in the LVOT view (b), show a huge vegetation on the aortic valve (white arrows). MSCT acquisitions with MPR in the LVOT view (c) on the level of aortic annulus (d) are displayed in a narrowed imaging window, suitable for analysing para-valvular tissue, and show an abscess located in the anterior part of the aortic root (black arrows)
Mentions: An abscess is a closed purulent collection. It is defined on echocardiography as a thickened, non-homogenous peri-valvular area with an echo-dense or echo-lucent appearance [1]. On MSCT, a peri-valvular abscess appears as a peri-valvular collection of liquid density surrounded by a thick layer of inflammatory tissue enhanced by injection of contrast medium (Fig. 4). Abscesses can infiltrate the structures surrounding the valve such as the LV myocardium or the inter-atrial septum. Abscesses are more frequently observed on the aortic valve and in prosthetic valve IE [6].Fig. 4

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