Which diagnostic test is most sensitive for diagnosing endocarditis?

The transesophageal echocardiogram is the most sensitive diagnostic test for diagnosing endocarditis. This method involves an ultrasound probe being inserted into the esophagus, which allows for closer proximity to the heart compared to a transthoracic echocardiogram. Because of this close proximity, it provides superior imaging of the heart structures, valves, and potential vegetation associated with endocarditis.

Patients with suspected endocarditis often have vegetations, which are masses of platelets, fibrin, and microorganisms. The transesophageal echocardiogram can detect these vegetations more effectively, especially in cases where the transthoracic echocardiogram may miss them due to limitations such as body habitus, lung interference, or the position of the heart. Therefore, when a healthcare provider has a high index of suspicion for endocarditis, utilizing a transesophageal echocardiogram is an important step to ensure accurate diagnosis and prompt management.

In contrast, testing options such as chest computed tomography or electrocardiogram are less relevant for the direct assessment of endocarditis. The transthoracic echocardiogram, while helpful, does not match the sensitivity of the transesophageal approach, particularly in detecting more subtle vegetations or