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The Unsuspected Complications of Bacterial Endocarditis Imaged by Gallium-67 Scanning

Nuclear Medicine Department, St. Luke's Medical Center, Milwaukee, Wisconsin

Correspondence: For correspondence or reprints contact: Shobha P. Desai, MD, Resident, Nuclear Medicine Dept., St Luke's Medical Center, 2900 W. Oldahoma Ave., P.O. Box 2901, Milwaukee, WI 53201-2901.

ABSTRACT

In this case report, we present a patient with bacterial endocarditis who was evaluated by ⁶⁷Ga imaging for persistent fever despite treatment with multiple intravenous antibiotics. Although evidence of bacterial endocarditis was absent with ⁶⁷Ga imaging, the study demonstrated findings that represent complications of bacterial endocarditis. The procedure demonstrated moderate pericardial uptake of isotope and thus provided the first evidence of pericarditis which was later confirmed at surgery. The study also demonstrated mildly increased activity in the vicinity of the aortic root and right atrium. A sinus of valsalva abscess, complicating the underlying diagnosis of bacterial endocarditis, was found and treated with surgery and antibiotics. At autopsy 4 wk later, a persistence sinus of valsalva abscess was found which extended into the right atrium.