In patients who are symptomatic, a diagnostic evaluation including radiologi- cal, ultrasonographic, and invasive procedures such as joint aspiration for both diagnostic and therapeutic reasons is rec- ommended. Invasive procedures such as percutaneous drain- age of soft tissue or organ abscess may be needed. Surgical intervention, as mentioned above, may be required for radi- cal infection cure. For example, splenic abscesses generally require splenectomy or a drainage procedure because the usefulness of antimicrobial therapy is in preventing disease extension in the spleen and treating systemic infection rather than eliminating abscesses.314 Whether percutaneous aspira- tion or drainage of splenic abscesses can be performed safely and effectively should be decided by an experienced team of clinicians. Identification and management of metastatic foci of infec- tion are critically important in patients who require valve surgery. When feasible, all invasive procedures for the initial management of metastatic foci of infection should be done before valve surgery to reduce the likelihood of infecting a placed prosthetic valve or annuloplasty ring. Cerebrovascular imaging may be considered in all patients with left-sided IE who have no CNS signs or symptoms (see the Intracranial MAs section below). There are currently no other recommendations for routinely evaluating all patients with IE for metastatic foci of infection, although many clinicians rec- ommend such routine screening for all cases of S aureus IE. Rather, a directed workup is advocated on the basis of local- izing signs or symptoms. Depending on the site of interest, the choice of diagnostic procedure (eg, CT, MRI, ultrasonogra- phy) varies, and the selection should be individualized for each patient. The choice of procedure may require consultation with experts. 