Christine E. Groeninx van Zoelen

Corstiaan A. den Uil

Diederik Gommers

KS Simons

Sakir Akin

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Sakir AkinCorstiaan A. den UilChristine E. Groeninx van ZoelenDiederik GommersPET-CT for detecting the undetected in the ICUReceived: 2 May 2015Accepted: 12 May 2015Published online: 8 July 2015 The Author(s) 2015. This article is published with open access atSpringerlink.comS. Akin ())  C. A. den Uil  C. E. Groeninx van Zoelen D. GommersDepartment of Intensive Care, Erasmus Medical Center,Room H-626, ’s-Gravendijkwal 230, 3015, CE, Rotterdam,The Netherlandse-mail: s.akin@erasmusmc.nlTel.: 0031642675027Critically ill patients often have focuses of infection thatare difficult to detect. When conventional imaging tech-niques fail to demonstrate the focus of infection, FDG-PET-CT ([18F]fluorodeoxyglucose positron emissiontomography combined with computed tomography) canbe of value [1]. In this case, we present a 62-year-oldmale patient with a history of aplastic anemia. Two weeksfollowing allogenic stem cell transplantation, he wasadmitted to the ICU and intubated because of respiratoryfailure by severe Aspergillus pneumonia. His recoverywas complicated by persistent positive blood cultureswith Enterococcus faecium, Staphylococcus epidermidis(CNS), and Escherichia coli. No focus could be founddespite extensive investigations, including echography ofgreat vessels and transesophageal echocardiography(TEE). After 2 weeks, we performed a PET-CT and foundincreased activity of fluorodeoxyglucose accumulation atthe right atrial appendage (RAA) (Fig. 1). Retrospec-tively, there was an oscillating structure in the rightatrium visible on the stored TEE images that was initiallynot recognized. We had the working diagnosis of infectedthrombus. Intensive antibiotic therapy (meropenem andFig. 1 a PET/CT images of positive uptake in the right atrialappendage (arrow) of an immunocompromised patient withpersisting blood cultures for E. faecium, S. epidermidis (CNS)and E. coli. b Corresponding TEE picture (aortic valve, short axis,right ventricular inflow/outflow)Intensive Care Med (2016) 42:111–112DOI 10.1007/s00134-015-3936-5 IMAGING IN INTENSIVE CARE MEDICINEvancomycin) was continued for 6 weeks combined withtherapeutic dosages of unfractionated heparin (UFH),after which blood cultures became negative. Duringrepeat TEE after 12 weeks the RAA thrombus had con-siderably reduced. After weaning from ventilation, thepatient was discharged from ICU after 15 weeks in areasonable condition.In conclusion, the use of the FDG-PET-CT should beconsidered in ICU patients for detection of a focus duringunexplained positive blood cultures. The PET scan shouldbe organized in ICU ensuring discontinuation of glucoseor insulin-containing intravenous infusions (for at least6 h) and injection of intravenous radiolabeled FDG in thescan room 1 h before starting the examinations, therebyallowing the patient to return to the ICU within 3 h.Conflicts of interest On behalf of all authors, the correspondingauthor states that there is no conflict of interest.Open Access This article is distributed under the terms of theCreative Commons Attribution-NonCommercial 4.0 InternationalLicense (http://creativecommons.org/licenses/by-nc/4.0/), whichpermits any noncommercial use, distribution, and reproduction inany medium, provided you give appropriate credit to the originalauthor(s) and the source, provide a link to the Creative Commonslicense, and indicate if changes were made.Reference1. Simons KS, Pickkers P, Bleeker-RoversCP, Oyen WJ, van der Hoeven JG (2010)F-18-fluorodeoxyglucose positronemission tomography combined with CTin critically ill patients with suspectedinfection. Intensive Care Med36:504–511112

Intensive Care Medicine

PET-CT for detecting the undetected in the ICU

https://link.springer.com/content/pdf/10.1007%2Fs00134-015-3936-5.pdf

PET-CT for detecting the undetected in the ICU

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