Noncardiac Thoracic Computed Tomography for the Detection of Infective Endocarditis: Worth a Glimpse.

We read with interest the review on infective endocarditis for perioperative clinicians by Jain et al.1Jain A Subramani S Gebhardt B et al.Infective endocarditis-update for the perioperative clinician.J Cardiothorac Vasc Anesth. 2023; 37: 637-649Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We support their contention that transthoracic and transoesophageal echocardiography are the imaging tools of choice, and that planned cardiac computed tomography (CT) is justified only in certain clinical situations. However, noncardiac, thoracic CT with angiographic contrast may be performed in patients with sepsis without strong suspicion of infective endocarditis. In contrast to classical sepsis origins (pulmonary focus, abdomen, or urinary tract), the heart receives less attention when routine thoracic CT scans are interpreted.2Kuetting D Müller A Feisst A et al.Incidental cardiac findings in non-electrocardiogram-gated thoracic computed tomography of intensive care unit patients: Assessment of prevalence and underreporting.J Thorac Imaging. 2018; 33: 168-175Crossref PubMed Scopus (5) Google Scholar However, vegetation can sometimes be visible as a hypodense structure on non-gated contrast thoracic CT.3Kanza RE Allard C Berube M. Cardiac findings on non-gated chest computed tomography: A clinical and pictorial review.Eur J Radiol. 2016; 85: 435-451Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,4Basyal B Clark PA Cohen JE et al.Rare case of infective endocarditis from invasive aspergillosis encasing the pulmonary valve: A case report.Eur Heart J Case Rep. 2023; 7: ytad218Crossref PubMed Scopus (0) Google Scholar Although motion artifacts of the beating heart reduce the image quality of nongated thoracic CT, modern multidetector CT scanners work fast enough to enable the detection of many cardiac pathologies.2Kuetting D Müller A Feisst A et al.Incidental cardiac findings in non-electrocardiogram-gated thoracic computed tomography of intensive care unit patients: Assessment of prevalence and underreporting.J Thorac Imaging. 2018; 33: 168-175Crossref PubMed Scopus (5) Google Scholar We recently had an illustrative case that supported our hypothesis. A 76-year-old woman was transferred to us with methicillin-sensitive Staphylococcus aureus bacteremia of unknown origin. We performed noncardiac thoracic and abdominal CT to identify the infection's source. A bean-shaped, hypodense structure attached to the mitral valve (Fig 1, A) was recognized. Mitral annular calcification was also present (Fig 1, B). A vegetation of 13 × 8 mm adhering to the atrial side of the posterior mitral leaflet was confirmed subsequently by transesophageal echocardiography (Fig 1, C). The endocarditis caused moderate mitral insufficiency (Fig 1, D). As in our patient, vegetations form more frequently on the atrial side of the mitral valve because of the lower flow velocity and pressure in the atrial chamber.5Martinez G Valchanov K. Infective endocarditis.BJA Educ. 2012; 12: 134-139Google Scholar,6Bora V Odo N Chura M et al.“Golf ball” in the left ventricular outflow tract?.Anesthesiology. 2018; 128: 388Crossref PubMed Scopus (0) Google Scholar Annular calcification, which is visible on noncardiac thoracic CT without a contrast agent,7Gondrie MJ van der Graaf Y Jacobs PC et al.The association of incidentally detected heart valve calcification with future cardiovascular events.Eur Radiol. 2011; 21: 963-973Crossref PubMed Scopus (50) Google Scholar also may predispose to endocarditis with S. aureus species.8Kumar A Samra G Kaur S et al.Mitral annular calcification related infective endocarditis: A contemporary systematic review.Curr Probl Cardiol. 2023; 48101558Crossref Scopus (0) Google Scholar Modern noncardiac thoracic CT is not intended to diagnose infective endocarditis, but we recommend screening thoracic images for suspicious cardiac structures whenever a patient with sepsis of unknown origin is investigated. None. Infective Endocarditis—Update for the Perioperative ClinicianJournal of Cardiothoracic and Vascular AnesthesiaVol. 37Issue 4PreviewInfective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Full-Text PDF