Unexpected septic pulmonary embolism imaging with 18-F FDG PET/CT in an infective endocarditis case: case report

Background Infective endocarditis (IE) is a severe disease that is diagnosed using a combination of clinical, microbiologic, and imaging criteria (modified Duke criteria). The prognosis relies on the degree of valvular involvement and crucially the presence of systemic infectious embolism. We present an educational infective endocarditis case with images of 18-F fluoro-D-glucose positron emission tomography/computed tomography (18-F FDG PET/CT) showing hypermetabolic lesions on the prosthetic tricuspid valve and papillary muscle of right ventricle. Besides these lesions, PET/CT showed an unexpected hypermetabolic extra-cardiac focus. Case presentation A 36-year-old male patient with IE history was underwent 18-F FDG PET/CT imaging. FDG PET revealed hypermetabolic lesions on the prosthetic tricuspid valve and papillary muscle of right ventricle. Besides these lesions, PET/CT showed an unexpected hypermetabolic focus in the lower lobe of the right lung, which was consistent with septic pulmonary embolism. Conclusions 18-F FDG PET/CT is a valuable, noninvasive imaging modality in diagnosis of prosthetic valve IE. It could change treatment planning since detecting extra-cardiac lesions.