Endocarditis

Preliminary Diagnosis: Endocarditis

I. What imaging technique is first-line for this diagnosis?

Echocardiogram.

II. Describe the advantages and disadvantages of this technique for diagnosing endocarditis.

Advantages

• Highly portable, quick imaging modality,

• Does not expose patients to ionizing radiation.

• Less expensive compared to MR imaging.

• Able to evaluate the cardiac structures with great specificity and able to evaluate chamber pressures.

• Able to detail vegetations from endocarditis.

Disadvantages

• Highly operator dependent.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to echocardiography exist.

IV. What alternative imaging techniques are available?

Cardiac MR.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing endocarditis.

Advantages

• Offers exquisite visualization of the surrounding soft tissues, osseuous structures, and vasculature.

• Cardiac MR Cine imaging may offer a dynamic evaluation of the blood flow through the chambers and valves.

• Able to evaluate for valvular vegetations, but unable to give the gold standard histological diagnosis.

Disadvantages

• Expensive.

• Time consuming.

• Offers poor evaluation of the surrounding osseous structures.

• Subject to motion and susceptibility weighted artifact, thus degrading imaging quality.

• Cardiac MR imaging must be cardiac gated.

VI. What are the contraindications for the alternative imaging techniques?

Contraindicated in patients with non-MR compatible hardware.