Asbjørn Mathias Scholtens et al. JIMG 2016;9:

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Presentation transcript:

Asbjørn Mathias Scholtens et al. JIMG 2016;9:1462-1465 Infection Versus Inflammation (A) Images show a patient with both aortic and mitral mechanical PHV with intense 18F-FDG uptake in the entire basal septum extending to both PHV. Minor uptake in the lateral wall is physiological based on incomplete suppression. Antibiotics did not change the clinical presentation, and re-evaluation of biopsy samples led to the diagnosis of sterile granuloma, possibly sarcoidosis. Symptoms diminished under corticosteroid therapy. (B) Images show a patient with suspicion of endocarditis of biological PHV and Bentall prosthesis. There is intense accumulation of 18F-FDG surrounding the implant (aortic valve and ascending aorta), indicative of widespread inflammation. During implantation, surgical adhesive had been applied to ensure hemostasis. The accumulation of 18F-FDG is most likely based on sterile inflammation due to the surgical adhesive and not due to infective endocarditis. This was confirmed during unrelated thoracic surgery. These images highlight the inability to reliably differentiate between infection and sterile inflammatory processes. Abbreviations as in Figures 1 and 2. Asbjørn Mathias Scholtens et al. JIMG 2016;9:1462-1465 American College of Cardiology Foundation