Key result
Non-gated thoracoabdominal CTA identifies mitral leaflet perforation and vegetation missed on multiple prior echocardiograms.
Why the study?
In patients with recurrent infective endocarditis and complex prosthetic cardiovascular material, the complementary value of thoracoabdominal CTA for detecting valvular complications after serial echocardiograms is not well characterized.
Can nongated thoracoabdominal CTA detect mitral leaflet perforation and vegetation missed by serial echocardiograms in a patient with recurrent infective endocarditis and complex cardiovascular prosthetic material?
Case Report (n=1)
Can nongated thoracoabdominal CTA detect mitral leaflet perforation and vegetation missed by serial echocardiograms in a patient with recurrent infective endocarditis and complex cardiovascular prosthetic material?
Routine non-cardiac, nongated thoracoabdominal CTA can opportunistically detect critical valvular complications like leaflet perforation in high-risk patients with recurrent infective endocarditis.
Opportunistic cardiac review on nongated thoracoabdominal CTA may detect endocarditis complications missed by echo; leaves open routine adoption pending validation.
(MRSA) endocarditis and bacteremia, chronic thoracic osteomyelitis, chronic bilateral hip prosthetic joint infection, heart failure with reduced ejection fraction, severe mitral regurgitation, complete heart block with a permanent pacemaker, paroxysmal atrial fibrillation, and multiple additional comorbidities. He was transferred for hemoptysis and fever, and thoracoabdominal CTA was obtained to evaluate for an aorto-bronchial fistula. The CTA showed no evidence of aorto-bronchial fistula and demonstrated decreased peri-graft fluid compared with prior imaging. Systematic cardiac review demonstrated a focal anterior mitral leaflet defect with an adjacent 0.9 cm hypoattenuating lesion along the left atrial surface, suspicious for leaflet perforation with vegetation. The abnormality had not been reported on two transesophageal echocardiographs (TEEs) and four transthoracic echocardiographs (TTEs) performed earlier in the same year. This case highlights the complementary value of careful cardiac valve assessment on non-coronary CTA in patients with recurrent endocarditis and complex prosthetic cardiovascular material.
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Öztürk et al. (2026) conducted a case report in Recurrent infective endocarditis (n=1). Thoracoabdominal CT Angiography (CTA) vs. Serial echocardiograms (TEE and TTE) was evaluated on Detection of mitral leaflet perforation or vegetation. Non-gated thoracoabdominal CT angiography incidentally detected an anterior mitral leaflet perforation and suspected vegetation that were not reported on multiple prior echocardiographic examinations.
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