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Multimodality imaging in a diagnostic and therapeutic process of a patient with infective endocarditis

Maria Binkiewicz-Orluk
Maria Binkiewicz-Orluk
, 
Marcin Konopka
Marcin Konopka
, 
Katarzyna Sierakowska-Sitkiewicz
Katarzyna Sierakowska-Sitkiewicz
, 
Wojciech Król
Wojciech Król
, 
Leszek Królicki
Leszek Królicki
, 
Marek Kuch
Marek Kuch
 and 
Wojciech Braksator
Wojciech Braksator
   | Mar 31, 2020
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Article Category: case-report
Published Online: Mar 31, 2020
Page range: 61 - 66
Received: Nov 20, 2019
Accepted: Feb 02, 2020
DOI: https://doi.org/10.15557/jou.2020.0010
Keywords
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Computed tomography of the head without contrast-enhancement. A. Red arrows indicate a large, hypodense region corresponding to an ischemic focus within the temporal lobe. B. Follow-up after 25 days of treatment: a cortical-subcortical focus of ischemic stroke within the right temporal lobe with calcifications on the cortex outlines
Computed tomography of the head without contrast-enhancement. A. Red arrows indicate a large, hypodense region corresponding to an ischemic focus within the temporal lobe. B. Follow-up after 25 days of treatment: a cortical-subcortical focus of ischemic stroke within the right temporal lobe with calcifications on the cortex outlines

Fig. 2.

Contrast-enhanced computed tomography of the abdomen. A. Green arrows point to a hypodense, triangular region corresponding to an infarction focus within the spleen. B. Red arrow shows a slight hypodense region in the left renal cortex, corresponding to an infarction focus of the kidney
Contrast-enhanced computed tomography of the abdomen. A. Green arrows point to a hypodense, triangular region corresponding to an infarction focus within the spleen. B. Red arrow shows a slight hypodense region in the left renal cortex, corresponding to an infarction focus of the kidney

Fig. 3.

Transthoracic echocardiography. A. Sternal, long-axis view: a structure linked with aortic valve cusps, corresponding to a vegetation. B. Suprasternal view with blood flow assessment in the descending aorta using pulsed Doppler: arrows indicate holodiastolic flow indicating considerable regurgitation. C and D. Parasternal, long-axis views, zoomed aortic valve (ZOOM): changes in the position of the vegetation depending on the cardiac cycle: systole ( C ), diastole ( D ). AoAsc – ascending aorta, LA – left atrium, LV – left ventricle, RV – right ventricle, * – pericarcial fluid
Transthoracic echocardiography. A. Sternal, long-axis view: a structure linked with aortic valve cusps, corresponding to a vegetation. B. Suprasternal view with blood flow assessment in the descending aorta using pulsed Doppler: arrows indicate holodiastolic flow indicating considerable regurgitation. C and D. Parasternal, long-axis views, zoomed aortic valve (ZOOM): changes in the position of the vegetation depending on the cardiac cycle: systole ( C ), diastole ( D ). AoAsc – ascending aorta, LA – left atrium, LV – left ventricle, RV – right ventricle, * – pericarcial fluid

Fig. 4.

Abdominal ultrasound with a sector echocardiography transducer: a triangular area of infarction in the spleen (also seen in computed tomography of the abdomen shown in Fig. 2A)
Abdominal ultrasound with a sector echocardiography transducer: a triangular area of infarction in the spleen (also seen in computed tomography of the abdomen shown in Fig. 2A)

Fig. 5.

Echocardiography, high transesophageal view, long axis. A. 35 days after aortic valve replacement: a thickening seen at the site of valvular prosthesis implantation. B. 54 days after surgery: a slight paravalvular aneurysm is seen at the site of previous wall thickening. C. Clearly visible inflow gate: the aneurysm communicates with the left ventricular outflow tract. D. Color Doppler presents evidence of flow within the lesion. Abbreviations: AoAsc – ascending aorta, LA – left atrium, LV – left ventricle, RV – right ventricle, * – a space corresponding to the paravalvular aneurysm
Echocardiography, high transesophageal view, long axis. A. 35 days after aortic valve replacement: a thickening seen at the site of valvular prosthesis implantation. B. 54 days after surgery: a slight paravalvular aneurysm is seen at the site of previous wall thickening. C. Clearly visible inflow gate: the aneurysm communicates with the left ventricular outflow tract. D. Color Doppler presents evidence of flow within the lesion. Abbreviations: AoAsc – ascending aorta, LA – left atrium, LV – left ventricle, RV – right ventricle, * – a space corresponding to the paravalvular aneurysm

Fig. 6.

Magnetic resonance imaging of the lumbosacral spine. A. A low-signal region on T1-weighted images within the L5 and S1 vertebral bodies. B and C. Arrows indicate areas of increased signal on T2-weighter images
Magnetic resonance imaging of the lumbosacral spine. A. A low-signal region on T1-weighted images within the L5 and S1 vertebral bodies. B and C. Arrows indicate areas of increased signal on T2-weighter images

Fig. 7.

18-fluorodeoxyglucose positron emission tomography. A. Enhanced tracer accumulation within the palatine tonsils. B. Enhanced and diffuse tracer accumulation in the superior part of the mesosternum: the findings correspond to the healing process after sternotomy. C. Diffuse area of enhanced tracer accumulation within the L5/S1 vertebral bodies: the entire image suggests inflammatory nature of the lesions. D. A peripheral, subcapsular region of enhanced tracer accumulation in the spleen. It corresponds to an infarction focus seen also on abdominal ultrasound (Fig. 4) and computed tomography (Fig. 2A)
18-fluorodeoxyglucose positron emission tomography. A. Enhanced tracer accumulation within the palatine tonsils. B. Enhanced and diffuse tracer accumulation in the superior part of the mesosternum: the findings correspond to the healing process after sternotomy. C. Diffuse area of enhanced tracer accumulation within the L5/S1 vertebral bodies: the entire image suggests inflammatory nature of the lesions. D. A peripheral, subcapsular region of enhanced tracer accumulation in the spleen. It corresponds to an infarction focus seen also on abdominal ultrasound (Fig. 4) and computed tomography (Fig. 2A)
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