Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

Detection of Perivalvular Abscess with Late Gadolinium-Enhanced MR Imaging in a Patient with Infective Endocarditis

  • Ryu, Seong-Yoon (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hae Jin (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sung Mok (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Sung-Ji (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Yeon Hyeon (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2016.03.17
  • Accepted : 2016.03.21
  • Published : 2016.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

We report a case of perivalvular abscess in a 66-year-old man with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. No clinical features suspicious of infective endocarditis were noted, however, transthoracic echocardiography revealed non-specific echogenic focal wall thickening at mitral-aortic intervalvular fibrosa. Perivalvular abscess in the aortic valve was demonstrated as focal wall thickening between the anterior mitral leaflet and the non-coronary cusp of the aortic valve with peripheral enhancement and central low signal intensity on LGE CMR imaging. Other features suggestive of infective endocarditis, such as neither vegetation nor valvular perforation were present. The perivalvular abscess did not grow after intensive intravenous antibiotics therapy, and the patient was discharged without surgical treatment. CMR with LGE provided an early accurate diagnosis of perivalvular abscess. The diagnosis of perivalvular abscess using LGE CMR imaging was not previously reported in Korea.

Keywords

References

  1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the american heart association. Circulation 2015;132:1435-1486 https://doi.org/10.1161/CIR.0000000000000296
  2. Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 2010;11:202-219 https://doi.org/10.1093/ejechocard/jeq004
  3. Bruun NE, Habib G, Thuny F, Sogaard P. Cardiac imaging in infectious endocarditis. Eur Heart J 2014;35:624-632 https://doi.org/10.1093/eurheartj/eht274
  4. Feuchtner GM, Stolzmann P, Dichtl W, et al. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol 2009;53:436-444 https://doi.org/10.1016/j.jacc.2008.01.077
  5. Harris KM, Ang E, Lesser JR, Sonnesyn SW. Cardiac magnetic resonance imaging for detection of an abscess associated with prosthetic valve endocarditis: a case report. Heart Surg Forum 2007;10:E186-187 https://doi.org/10.1532/HSF98.20061210
  6. Sverdlov AL, Taylor K, Elkington AG, Zeitz CJ, Beltrame JF. Images in cardiovascular medicine. Cardiac magnetic resonance imaging identifies the elusive perivalvular abscess. Circulation 2008;118:e1-3
  7. Dursun M, Yilmaz S, Yilmaz E, et al. The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results. Diagn Interv Radiol 2015;21:28-33 https://doi.org/10.5152/dir.2014.14239
  8. Saby L, Le Dolley Y, Laas O, et al. Early diagnosis of abscess in aortic bioprosthetic valve by 18F-fluorodeoxyglucose positron emission tomography-computed tomography. Circulation 2012;126:e217-220
  9. Pizzi MN, Roque A, Fernandez-Hidalgo N, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography angiography: initial results at an infective endocarditis referral center. Circulation 2015;132:1113-1126 https://doi.org/10.1161/CIRCULATIONAHA.115.015316

Cited by

  1. Diagnosis of Right Ventricular Vegetation on Late Gadolinium-Enhanced MR Imaging in a Pediatric Patient after Repair of a Ventricular Septal Defect vol.20, pp.2, 2016, https://doi.org/10.13104/imri.2016.20.2.114