What diagnostic imaging is indicated for a patient with suspected infective endocarditis presenting with cough and dyspnea?

The most appropriate diagnostic imaging for a patient with suspected infective endocarditis, especially when there are respiratory symptoms like cough and dyspnea, is transesophageal echocardiography. This modality provides a detailed view of the heart's structures and is particularly effective in identifying vegetations on heart valves, abscesses, or other complications associated with endocarditis. Transesophageal echocardiography is more sensitive than transthoracic echocardiography for detecting these issues, especially in patients with complex anatomy or in those who are difficult to image with other methods.

Additionally, in cases of suspected infective endocarditis, identifying the presence of vegetations is crucial for both diagnosis and management, as it directly impacts treatment decisions. The respiratory symptoms may suggest embolic events in the lungs due to septic emboli originating from the heart, reinforcing the need for thorough cardiac evaluation to assess for potential complications associated with the endocarditis.

While a chest X-ray could provide some information about pulmonary complications, it would not adequately assess the cardiac structures. CT angiography is more useful for vascular imaging and might not offer the necessary details of cardiac vegetations or heart valve morphology. An ultrasound of the heart, particularly transthoracic echocardiography,