Limits...
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 MSCT studies in case of aortic valve infective endocarditis. MPR reconstructions are shown at sagittal oblique view (a), coronal oblique view at the level of the aortic root (b) and at aortic valve plane view (c). Images show a pseudoaneurysm with a communication between the aortic lumen and the neocavity (white arrows) around a degenerative, calcified, bicuspid aortic valve
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4195843&req=5

Fig5: Results of MSCT studies in case of aortic valve infective endocarditis. MPR reconstructions are shown at sagittal oblique view (a), coronal oblique view at the level of the aortic root (b) and at aortic valve plane view (c). Images show a pseudoaneurysm with a communication between the aortic lumen and the neocavity (white arrows) around a degenerative, calcified, bicuspid aortic valve

Mentions: Pseudoaneurysm is an abscess that has ruptured into a cardiac cavity or at the aortic root or can be due to a para-valvular leak due to the infection. On echocardiography a pseudoaneurysm is pulsatile with colour Doppler flow detected in the cavity [1]. On MSCT it appears as an abnormal cavity close to the valve, enhancing concomitantly with the cardiac or aortic lumen (Fig. 5). Communication between the cardiac cavity and pseudoaneurysm may not be detectable if the pseudoaneurysm has developed around the mitral valve.Fig. 5


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 MSCT studies in case of aortic valve infective endocarditis. MPR reconstructions are shown at sagittal oblique view (a), coronal oblique view at the level of the aortic root (b) and at aortic valve plane view (c). Images show a pseudoaneurysm with a communication between the aortic lumen and the neocavity (white arrows) around a degenerative, calcified, bicuspid aortic valve
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Results of MSCT studies in case of aortic valve infective endocarditis. MPR reconstructions are shown at sagittal oblique view (a), coronal oblique view at the level of the aortic root (b) and at aortic valve plane view (c). Images show a pseudoaneurysm with a communication between the aortic lumen and the neocavity (white arrows) around a degenerative, calcified, bicuspid aortic valve
Mentions: Pseudoaneurysm is an abscess that has ruptured into a cardiac cavity or at the aortic root or can be due to a para-valvular leak due to the infection. On echocardiography a pseudoaneurysm is pulsatile with colour Doppler flow detected in the cavity [1]. On MSCT it appears as an abnormal cavity close to the valve, enhancing concomitantly with the cardiac or aortic lumen (Fig. 5). Communication between the cardiac cavity and pseudoaneurysm may not be detectable if the pseudoaneurysm has developed around the mitral valve.Fig. 5

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