Fig. 2: Serial computed tomography and positron emission tomography computed tomography images illustrating the progress of the vascular graft infection before and after phage therapy.

A CT Aortogram (Thorax) on 6 February 2024, following her Bentall procedure, showing heterogeneous anterior mediastinal collection with gas locules surrounding the aortic arch and ascending aorta. There is gas seen tracking through the midline sternotomy (yellow arrow). B CT Aortogram on 23 April 2024 shows resolution of the pneumomediastinum but there is interval development of a hyperdense rind along the ascending aorta and within the anterior mediastinum. C–E Pre-phage therapy attenuation corrected 18F-FDG PET image. CT image and fusion 18F- FDG PET/CT images at different time points in chronological order. There is an initial intense 18-FDG-avid focus of uptake posterior to the sternotomy wire (red arrow). This shows interval decrease in intensity and then subsequent metabolic resolution by 10 September 2024. However, there is serial interval increase in the circumferential 18F-FDG uptake around the aortic valve prosthesis (orange arrow), suggestive of an underlying active infective/inflammatory process. F,G. Post-phage therapy attenuation corrected 18F-FDG PET image. CT image and fusion 18F-FDG PET/CT images at different time points in chronological order. The most intense tracer uptake around the graft was seen in September 2024, and following phage therapy, there is interval sustained improvement following the administration of phage therapy showing interval decrease intensity of the circumferential 18F-FDG uptake along the aortic valve prosthesis (orange arrow).