What is the most sensitive and specific imaging study for diagnosing endocarditis?

Transesophageal echocardiography is considered the most sensitive and specific imaging study for diagnosing endocarditis due to its superior ability to visualize cardiac structures compared to other modalities. This technique allows for a closer and more detailed examination of the heart valves and chambers, particularly in areas that are difficult to view with transthoracic echocardiography, such as the left atrium and the posterior parts of the heart.

Endocarditis is often characterized by the presence of vegetations on the heart valves, which can lead to significant morbidity if not detected early. Transesophageal echocardiography can detect these vegetations with higher sensitivity, especially in patients with prosthetic valves or in those with other complicating factors such as obesity or lung disease that may limit transthoracic imaging.

In contrast, while chest X-rays can provide indirect signs of endocarditis (like heart enlargement or pulmonary edema), they lack specificity and sensitivity for the disease itself. Transthoracic echocardiography also plays a crucial role in the diagnosis but is not as effective as transesophageal echocardiography in providing detailed imaging required for accurate diagnosis. CT Angiography is primarily used for vascular imaging and would not be the first-line imaging study for endocard