Fluorine-18–Labeled Deoxyglucose Positron Emission Tomography in the Diagnosis and Management of Aortitis With Pulmonary Artery Involvement

Abstract

A 58-year-old woman presented with a complex history of constitutional symptoms, heart block requiring pacemaker, and subsequent heart failure. Initial echocardiograms reported some periaortic thickening but no definite vegetations. The patient had received antibiotic therapy before initial presentation. She had multiple negative serial blood cultures and was treated for culture-negative endocarditis. Over the ensuing months, however, her condition progressively worsened. At the time of her presentation to our facility, she had persistent elevations of her C-reactive protein (CRP; 66 mg/dL), an accelerated erythrocyte sedimentation rate (ESR; 60 mm/h), and a P-antineutrophil cytoplasmic antibody (ANCA) immunofluorescence assay that was positive. She had negative serology for bartonella, coxiella, and brucella, as well as nonreactive syphilis and human immunodeficiency virus …