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Vascular Graft Infection PET — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionVascular Graft Infection PETSCE Infectious Diseases

A 50-year-old man with a history of aortic root replacement with a composite graft develops low-grade fever, malaise, and raised inflammatory markers 2 years post-surgery. Blood cultures are repeatedly negative. FDG PET-CT shows intense uptake around the aortic graft. CT angiography shows a small peri-graft fluid collection. What is the most likely diagnosis?

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Correct answer: E — Prosthetic vascular graft infection — PET-CT is the most sensitive imaging modality for detecting vascular graft infection

Prosthetic vascular graft infection presents insidiously with low-grade fever, weight loss, and raised inflammatory markers — often with negative blood cultures (especially with low-virulence organisms like C. acnes or CoNS). FDG PET-CT has transformed diagnosis — it detects metabolically active peri-graft infection with high sensitivity and specificity. CT angiography may show peri-graft fluid or gas. Management requires prolonged IV antibiotics (often 6 weeks+) and frequently surgical graft explantation with in-situ or extra-anatomic reconstruction. Culture of explanted graft material provides microbiological diagnosis.

Reference: ESC 2023 – Vascular graft infection; ESVS 2020 – Vascular graft infection; NICE 2024