Figure 7.

Example of the use of multimodality imaging. A patient with history of aortic valve replacement with mechanical prosthesis and ascending aorta graft presented four years later with acute right lower limb ischemia due to occlusion of proximal fibular, anterior tibial, and posterior tibial arteries treated with revascularization attempts and finally leg amputation. During hospitalization, the patient had fever with increased erythrocyte sedimentation rate and C-reactive protein. TTE (A) and at TOE (B,C) show the presence of hyperechogenic periprosthetic area (white arrows), most likely consistent with abscess. Blood culture was negative. The fluoro-18-fluorodeoxyglucose positron emission tomography/computed tomography ((¹⁸F)FDG PET/CT) exam including CCTA (D-J) was performed showing an organized fluid perigraft collection surrounded by thick walls (asterisk) that enhance after iodinated contrast injection on CCTA images (D), which is associated to intense uptake of (¹⁸F)FDG around the aortic valve prosthesis, as shown by the yellow arrows ((E,G) show noncontrast CT transaxial images while (F,H) show the fused PET/CT images). Myocardial suppression of (¹⁸F)FDG uptake is achieved by high-fat, low-carb diet. In addition, the whole-body images showed an area of spleen uptake, consistent with septic embolism ((I,J), noncontrast CT and fused PET/CT transaxial images, respectively), as indicated by the yellow arrow. Ao: ascending aorta; LV: left ventricle.