{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:29:55Z","timestamp":1765189795210,"version":"3.46.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infected left ventricular (LV) thrombus is a rare but serious complication in patients with heart failure with reduced ejection fraction (HFrEF). It is associated with persistent bacteraemia, systemic embolization, and stroke. Diagnosis requires a high index of clinical suspicion, supported by multimodal imaging and coordinated multidisciplinary management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>We report a 69-year-old man with ischaemic cardiomyopathy (EF 30%), prior multi-territory stroke due to LV thrombus, and multiple comorbidities, who was admitted with reduced GCS following ICU treatment for Streptococcus anginosus septic shock. Despite several antibiotic courses, he experienced recurrent bacteraemia over 6\u2005months with no clear source. Given his history, an infected LV thrombus and infective endocarditis were considered. Transthoracic echocardiography (TTE) demonstrated recurrence of an apical thrombus, which was confirmed on transoesophageal echocardiography (TOE) without valvular vegetations. FDG positron emission tomography (PET) showed focal uptake at the LV apex in a circular pattern with central photopenia, consistent with an infected thrombus. He was managed with 6\u2005weeks of intravenous benzylpenicillin followed by 6\u2005months of oral amoxicillin, alongside warfarin anticoagulation. Surgery was not pursued due to frailty and comorbidities. He improved clinically with the resolution of bacteraemia. Follow-up PET and TTE were planned to assess the response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case represents one of the few PET-confirmed infected LV thrombus presenting with persistent S. anginosus bacteraemia. It highlights the diagnostic value of multimodal imaging, particularly PET\/CT in distinguishing infected thrombus from sterile thrombus and endocarditis, and underscores the importance of prolonged antibiotic therapy, anticoagulation, and multidisciplinary management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf579","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T04:26:53Z","timestamp":1762662413000},"source":"Crossref","is-referenced-by-count":0,"title":["Infected left ventricular thrombus confirmed by FDG PET\/CT presenting as persistent\n                    <i>Streptococcus anginosus<\/i>\n                    bacteraemia in ischaemic cardiomyopathy: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5110-5658","authenticated-orcid":false,"given":"Nithin","family":"George","sequence":"first","affiliation":[{"name":"Department of Cardiology, Lyell McEwin Hospital , Haydown Road, Elizabeth Vale, Adelaide, SA 5112 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"2025120805264179000_ytaf579-B1","doi-asserted-by":"crossref","first-page":"00","DOI":"10.1161\/CIR.0000000000001092","article-title":"Management of patients at risk for and with left ventricular thrombus: a scientific statement from the American Heart Association","volume":"146","author":"Levine","year":"2022","journal-title":"Circulation"},{"key":"2025120805264179000_ytaf579-B2","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1016\/j.jacc.2019.01.031","article-title":"Left ventricular thrombus: contemporary etiologies, treatment strategies, and outcomes","volume":"73","author":"McCarthy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025120805264179000_ytaf579-B3","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC guidelines for the management of endocarditis: developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC)","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur Heart J"},{"key":"2025120805264179000_ytaf579-B4","first-page":"847","article-title":"The clinical view on Streptococcus anginosus group \u2013 opportunistic pathogens coming out of hiding","volume":"11","author":"Pilarczyk-Zurek","year":"2022","journal-title":"Pathogens"},{"key":"2025120805264179000_ytaf579-B5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/ejechocard\/jeq004","article-title":"Recommendations for the practice of echocardiography in infective endocarditis","volume":"11","author":"Habib","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2025120805264179000_ytaf579-B6","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1016\/j.jmir.2023.12.012","article-title":"Infective endocarditis: the role of PET imaging in diagnosis and management","volume":"55","author":"Boczar","year":"2024","journal-title":"J Med Imaging Radiat Sci"},{"key":"2025120805264179000_ytaf579-B7","doi-asserted-by":"crossref","first-page":"101848","DOI":"10.1016\/j.nuclcard.2024.101848","article-title":"Translational molecular imaging: thrombosis imaging with positron emission tomography","volume":"31","author":"Balmforth","year":"2024","journal-title":"J Nucl Cardiol"},{"key":"2025120805264179000_ytaf579-B8","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s12350-011-9376-x","article-title":"Positron emission tomography scan can be a reassuring tool to treat difficult cases of infective endocarditis","volume":"18","author":"Kenzaka","year":"2011","journal-title":"J Nucl Cardiol"},{"key":"2025120805264179000_ytaf579-B9","doi-asserted-by":"crossref","first-page":"e010600","DOI":"10.1161\/CIRCIMAGING.120.010600","article-title":"Diagnosis of infective endocarditis by subtype using 18F-fluorodeoxyglucose positron emission tomography\/computed tomography: a contemporary meta-analysis","volume":"13","author":"Wang","year":"2020","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025120805264179000_ytaf579-B10","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1148\/rg.2016150225","article-title":"Infectious diseases of the heart: pathophysiology, clinical and imaging overview","volume":"36","author":"Murillo","year":"2016","journal-title":"RadioGraphics"},{"key":"2025120805264179000_ytaf579-B11","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1161\/CIR.0000000000000296","article-title":"Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications","volume":"132","author":"Baddour","year":"2015","journal-title":"Circulation"}],"container-title":["European Heart Journal - 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