P394 FROM A PET THE FIRST AND UNEXPECTED DIAGNOSTIC ORIENTATION

Abstract

Abstract Introduction Nuclear medicine plays an important role in the diagnosis and treatment of numerous pathologies. In the cardiology field it can be used to obtain a lot of information about ischemic heart disease, infiltrative heart disease and inflammatory and infectious diseases such as endocarditis. The greatest impact in the field of these latter pathologies was obtained using F–fluorodeoxyglucose (FDG) in the study of patients with implantable electronic devices and replaced valves or valve prostheses. In this regard, I report the case of a patient with results of valve tube implantation in which a PET performed to investigate an inflammatory pathology has allowed to make a diagnosis of endocarditis. Discussion The case concerns a 66–year–old man subjected to intervention of Bentall for type A aortic dissection (in 2015); chronic aortic dissection remains (Stanford B). Diabetic with chronic renal failure and COPD. Recovered in medicine for low back pain, dysuria and episodes of chills without pyrexia. High inflammatory indices but with urine culture and negative blood cultures performed on isolated febrile peak. CT scan of the chest negative for phlogistic localizations and for intense rachialgia in the suspicion of spondylodiscitis is subjected to total body PET that shows accumulation of radio compound in the first tract of the ascending aorta with greater anterior focality: hyper fixation is associated at the level of the lower limiter of L4 and L5. With these results therefore posed the suspicion of endocarditis for which started to perform transthoracic echocardiogram that did not identify certain pathological elements and transesophageal elements that instead showed suggestive images for endocarditic vegetation in aortic mechanical prosthesis (intravalvular mobile filiform appearance) and on the atrial side of the tricuspid valve (“soft” appearance of large dimensions). It is not associated with valvular dysfunction. After the echocardiographic finding, therapy with daptomycin in addition to piperacillin/tazobactam is initiated and the patient transferred to the infectious diseases department. Conclusions Bacterial endocarditis in particular in patients undergoing cardiac surgery or wearing implantable devices is often characterized by unusual clinical presentation as in this case, so it is not excessive to resort to second–level imaging such as transesophageal echocardiography and nuclear cardiology diagnostics.