Whether the Valve or the Septic Embolus Is Actively Infectious: A Possible Role of Gallium-67 Scan in a Patient of Infective Endocarditis Complicated with Septic Emboli

Received 2/25/2002; revised 3/22/2002; accepted 4/4/2002. For correspondence or reprints contact: Teng-Yao Yang, M.D., Department of Cardiology, Chang Gung Memorial Hospital, Chai-Yi; 6 Section West, Chai-Pu Road, Pu-Tz City, Chai-Yi 613, Taiwan, R.O.C. Tel: (886)5-3621000 ext. 2176, Email: [email protected] We reported a case of infective endocarditis involving the mitral valve and complicated with septic embolus to the right popliteal artery. After 6 weeks of antibiotic treatment, hemodynamic condition of the patient was stable but fever persisted. Echocardiography showed disappearance of the vegetation that was seen on the initial echocardiogram. Occlusion of the right popliteal artery by septic emboli was suspected by clinical findings and proved by duplex and magnetic resonance angiogram. Gallium-67 (Ga) scan revealed increased uptake over the right leg but not the heart. After embolectomy (without open heart surgery), the fever subsided. This case report suggests the possibility that Ga scan may play a role in this situation to find the infectious focus and avoid unnecessary open heart surgery.