Candida prosthetic valve endocarditis: The complementary role of multidetector computed tomography and transoesophageal echocardiography in preoperative evaluation

A 72-year-old man with previous mitral valve replacement and single coronary bypass surgery was diagnosed with recurrent candida endocarditis by transoesophageal echocardiography and positive blood cultures. Preoperative electrocardiogram-gated multidetector CT (MDCT) was ordered to evaluate the patency and course of the mammary graft. In addition to verifying graft patency, MDCT demonstrated a mobile vegetation on the mitral prosthesis as well as a vegetation on the posterior left atrial wall which was not visible by transoesophageal echocardiography. Multidetector CT also revealed signs of osteomyelitis in the thoracic spine. Repeated surgery confirmed these findings and mitral valve replacement with resection of the left atrial vegetation were performed. This case illustrates the complementary role of MDCT and echocardiography in the preoperative evaluation of fungal endocarditis.