99mtc-hmpao-labeled autologous leukocyte spect/ct for diagnosis of bacterial endocarditis of the prosthetic pulmonary conduit: a clinical case

In this paper, we present a case of bacterial endocarditis of the prostheticpulmonary conduit found in a 26-year-old man. anechocardiography study around the pulmonary valve showed the presence of a floating mass attached to the wall of the conduit. this formation was thought to be a floating calcific leaflet of the conduit or a developed vegetation of the conduit. due to the uncertainty of the results, pulmonary multidetector row computed tomography (mdct) angiography was performed. the mdct examination showed the presence of a floating 4 × 8-mm sized mass in the pulmonary conduit. taking into account the patient’s complaints, medical history data, and clinical-instrumental examination, myocardial scintigraphy with 99mtc-hmpao-labelled autologous leukocytes combined with ct (99mtc-hmpao-spect/ct) was performed. based on overlaying of the scintigraphic images and the mdct aortography scans, anatomic localization of the pathologic accumulation was found in a projection of the pulmonary valve prosthesis. surgical intervention, with cardiopulmonary bypass, was performed for replacement of the valve-containing conduit. pathomorphologic study of the surgical material confirmed the hypothesis of bacterial endocarditis. therefore, hybrid technologies such as 99mtc-hmpao-spect/ct contribute to the earlier and more precise diagnosis of infectious endocarditis, avoiding many errors associated with patient treatment and the development of complications.