Impact of 18F-FDG-PET/CT in Managing a Case of Fungal Prosthetic Valve Endocarditis.

Abstract

Approximately 0.1% of all prosthetic cardiac valves are affected by fungal endocarditis (bacterial endocarditis being the most common cause), which has a high case fatality rate. Post-treatment clinical improvement and a negative blood culture do not definitively rule out the presence of residual active disease. Among imaging techniques, trans-oesophageal echocardiography has higher sensitivity than transthoracic echocardiography, but has its own limitations. Functional imaging with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) has shown to have high overall sensitivity, specificity, and accuracy for the diagnosis and follow-up evaluation of prosthetic valve infective endocarditis, thereby significantly influencing clinical management. Here, we report a rare case of a patient with Marfan syndrome and fungal prosthetic valve endocarditis, in which ¹⁸F-FDG-PET/CT played a significant role in management decision.