F-FDG PET CT in cardiac device infections - A Case series.

With the increasing number of interventional cardiology procedures, the number of cardiac device infections (including pacemakers, prosthetic valves, coronary and aortic stents) have also increased. These infections can cause significant morbidity and can even lead to mortality if not managed promptly. If suspected clinically the first-line imaging modality is Trans-Thoracic Echocardiography, while Transesophageal Echocardiography is also used in selected cases. The confirmation of a cardiac device infection is mostly done with the help of blood or pus culture. Even though Echocardiography is a very efficient technique for the evaluation of the heart, it cannot differentiate infection from thrombus or fibrosis. With the increasing availability of Positron Emission Tomography CT (PET CT) machines worldwide, the use of F-FDG PET CT for infection imaging has gained traction, especially for cardiac device infection. Most of the recent studies show a good diagnostic accuracy of F-FDG PET CT with many of the recent diagnostic and management guidelines now acknowledging its role, especially in equivocal cases. We present six such cases where F-FDG PET CT provided valuable information either for diagnosis, confirming the presence of infection, delineating extent, therapy response or sometimes even helping appropriate treatment decision making in patients with suspected cardiac device infection.