PET/CT provides snapshot of E. coli coronary stent infection

Infection imaging with PET/CT is gaining traction and could help detect serious complications after coronary stent placement, as evidenced by an E. coli case study published online Aug. 24 in the Journal of Nuclear Cardiology.

A team of researchers including Horst Wedekind, MD, from the Department of Internal Medicine—Cardiology and Angiology at St. Franziskus Hospital Munster in Munster, Germany, and colleagues presented a patient case highlighting PET/CT’s ability to aid the diagnosis of coronary stent infection. Such complications are uncommon and could fall through the cracks. This imaging study provides a unique example of what might otherwise be a challenging case.

“Septic complications of coronary stent implantation are extremely rare,” wrote Wedekind et al. “We report a case of coronary drug eluting stent infection (DES) with purulent pericarditis after complex coronary intervention, which was diagnosed by PET/CT.”

The 80-year-old patient had received a percutaneous coronary intervention (PCI) and three weeks later showed up with chills, fever and blood-work with elevated troponin protein levels. Two separate cultures of E. coli solidified the diagnosis. The patient was treated for ten days with broad-spectrum antibiotics but experienced reoccurring infection. The patient was then referred for cardiac PET/CT imaging to assess coronary infection.

Results of the imaging study revealed infection at the site of implantation and distinguished the infection from non-infectious inflammation. Cardiac PET/CT also revealed pericardial effusion that was then drained and tested positive for E. coli. A change in patient management resulted and a different antibiotic treatment was continued for 12 months until the infection was successfully treated.

“In conclusion, coronary stent infection should be considered in the differential diagnosis of fever of unknown origin following PCI,” wrote the authors. This and other studies continue to build the case for cardiac infection imaging with FDG PET/CT.