Kamiyama Masaki, Higaki Akinori, Miyabe Ryo, Higashi Haruhiko, Inoue Katsuji, Yamaguchi Osamu
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan.
Department of Cardiology, Mimihara General Hospital, Osaka, Japan.
Oxf Med Case Reports. 2024 Apr 25;2024(4):omae026. doi: 10.1093/omcr/omae026. eCollection 2024 Apr.
Right-sided infective endocarditis (RSIE) generally carries a positive prognosis; however, it can result in complications such as heart failure, underscoring the importance of prompt diagnosis. While echocardiography serves as the standard diagnostic tool, it may occasionally face challenges in distinguishing between normal structures and vegetations. In this report, we present the case of a 60-year-old man diagnosed with pyogenic vertebral osteomyelitis, alongside suspected coexisting RSIE. During both transthoracic and transesophageal echocardiography, a rod-like mobile structure was observed adjacent to the right ventricular moderator band. However, confirming its nature as an infective vegetation proved challenging. Despite the inconclusive diagnosis of IE by echocardiography, the positron emission tomography/computed tomography (PET/CT) scan and cardiac magnetic resonance imaging (MRI) played a pivotal role in distinguishing between normal structures and vegetations. Since IE could develop life-threatening events, the role of multimodal imaging is of paramount importance. This case serves as a compelling example of the diagnostic value through the integration of PET/CT and MRI in ruling out IE.
右侧感染性心内膜炎（RSIE）通常预后良好；然而，它可能导致心力衰竭等并发症，这凸显了及时诊断的重要性。虽然超声心动图是标准的诊断工具，但在区分正常结构和赘生物时偶尔会面临挑战。在本报告中，我们介绍了一例60岁男性患者，诊断为化脓性脊椎骨髓炎，同时怀疑并存RSIE。在经胸和经食管超声心动图检查中，均在右心室节制索附近观察到一个棒状可移动结构。然而，证实其为感染性赘生物具有挑战性。尽管超声心动图对感染性心内膜炎的诊断尚无定论，但正电子发射断层扫描/计算机断层扫描（PET/CT）和心脏磁共振成像（MRI）在区分正常结构和赘生物方面发挥了关键作用。由于感染性心内膜炎可能引发危及生命的事件，多模态成像的作用至关重要。该病例有力地证明了PET/CT和MRI联合应用在排除感染性心内膜炎方面的诊断价值。
