Images in Cardiovascular Medicine Early Diagnosis of Abscess in Aortic Bioprosthetic Valve by 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography

Case 1 A 69-year–old woman, with an aortic bioprosthetic valve implanted 2 years before, was referred to our department because of a suspicion of endocarditis. She had experienced fever for 1 week, and Haemophilus parainfluenza was identified in 1 blood culture. The total white blood count (WBC) was 12 10/L, and the erythrocyte sedimentation rate (ESR) was 60 mm. The first transthoracic and transesophageal echocardiographic (TEE) studies were considered as normal. However, the 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT), performed the day after, revealed an intense fixation at the level of the bioprosthetic valve. Then, a treatment with ceftriaxone and gentamicin was started. Six days later, although fever persisted and ESR remained elevated, a second TEE showed the emergence of a periprosthetic abscess without any dehiscence (Figure 1 and Movies I and II). The lesions were confirmed during surgery performed thereafter.