Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3723_Библиотеки_им_академика_М_И_Перельмана

Extracardiac complications occur in 30–80% of patients [40, 41] and are known to increase mortality and worsen prognosis [42]. The ability of FDG PET/CT to detect distant extracardiac complications such as septic emboli and meta­static infection provides incremental diagnostic and prognostic information for CIED infection and CDRIE [2, 43]. Septic pulmonary emboli and spondylodiscitis are the most frequent distant infectious sites [9]. Septic pulmonary emboli are a common nding in CIED lead infection and CDRIE involving tricuspid valve infection. The presence of multiple and bilateral foci of FDG uptake, often associated with matching paren­chymal opacities on CT, is highly suggestive of septic emboli and accordingly of infection of the device [44]. In a prospective study, Amraoui etal. evaluated 35 patients with a denite diagnosis of CDRIE by Duke-Li criteria, and spondylodiscitis was identied on FDG PET/CT in 20% of patients, some being completely asymptomatic [45]. Vascular septic emboli and mycotic aneu­rysms are usually asymptomatic but might lead to vascular rupture, a life-threatening complication (Fig.14.1). The most common localization is in the brain and can be detected by MRI; however, it might occur anywhere else [46–48] (Fig.14.2). The other frequent sites of septic emboli are the same as encountered in IE and include the spleen and bone marrow. Boursier etal. demonstrated, in a cohort of 129 patients including 88 subjects with a denite diagnosis of IE, that diffuse high FDG uptake in the spleen and/or bone marrow (dened as superior to liver uptake) can be an indirect sign of IE [49].