 Introduction/Background Infective endocarditis can involve a normal, abnormal, or prosthetic cardiac valve. In recent years, infective endocarditis of normal right-sided valves has become more frequent because of intravenous (IV) injection of illicit drugs, indwelling IV catheters, and implantable cardiac devices [1-3]. In patients with implanted cardiac devices, it has become increasingly important to consider infections of the device leads, device generator, and device pocket [4]. The clinical presentation of endocarditis is heterogeneous, with patients often presenting with acute heart failure due to severe valve destruction, but many presenting insidiously. The physical examination often reveals a new heart murmur, most commonly due to valvular insufficiency, and evidence of heart failure or a myriad of potential embolic and inflammatory/immune-mediated sequelae. At the first clinical suspicion of infective endocarditis, the workup typically includes serial blood cultures and transthoracic echocardiography (TTE) [5,6]. Although infective endocarditis is typically diagnosed clinically with persistently positive blood cultures in association with characteristic symptoms and physical findings [5,7], and then further evaluated by echocardiography, blood cultures may be negative in the setting of antibiotic use. Imaging is used to support the diagnosis by demonstrating vegetations of cardiac valves and, in complicated cases, paravalvular abscesses affecting native [8] and prosthetic [9] valves. Imaging is also used to assess the severity of valvular damage, identify complications, recognize the presence and severity of heart failure, and inform the next steps in patient management [7,10]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a
Infective Endocarditis.  Introduction/Background Infective endocarditis can involve a normal, abnormal, or prosthetic cardiac valve. In recent years, infective endocarditis of normal right-sided valves has become more frequent because of intravenous (IV) injection of illicit drugs, indwelling IV catheters, and implantable cardiac devices [1-3]. In patients with implanted cardiac devices, it has become increasingly important to consider infections of the device leads, device generator, and device pocket [4]. The clinical presentation of endocarditis is heterogeneous, with patients often presenting with acute heart failure due to severe valve destruction, but many presenting insidiously. The physical examination often reveals a new heart murmur, most commonly due to valvular insufficiency, and evidence of heart failure or a myriad of potential embolic and inflammatory/immune-mediated sequelae. At the first clinical suspicion of infective endocarditis, the workup typically includes serial blood cultures and transthoracic echocardiography (TTE) [5,6]. Although infective endocarditis is typically diagnosed clinically with persistently positive blood cultures in association with characteristic symptoms and physical findings [5,7], and then further evaluated by echocardiography, blood cultures may be negative in the setting of antibiotic use. Imaging is used to support the diagnosis by demonstrating vegetations of cardiac valves and, in complicated cases, paravalvular abscesses affecting native [8] and prosthetic [9] valves. Imaging is also used to assess the severity of valvular damage, identify complications, recognize the presence and severity of heart failure, and inform the next steps in patient management [7,10]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a