Detection of pacemaker and lead infection with FDG-PET

Excerpt

A 40-year-old female with known Ebstein’s anomaly and a history of tricuspid valvuloplasty and pacemaker implantation for postoperative AV block in childhood underwent prosthetic tricuspid valve replacement because of symptomatic tricuspid regurgitation and pacemaker battery change. Three weeks after surgery, she was re-admitted because of fever, chills and tenderness around the pacemaker pocket for 2 days. No skin lesions supporting endocarditis were present. A pacemaker pocket infection was suspected. A multidrug antibiotic regimen covering staphylococcal infection was started on admission because of possible foreign body infection including the tricuspid prosthesis. Blood cultures showed growth of methicillin-susceptible Staphylococcus aureus. The patient responded well, as fever and tenderness over the pacemaker pocket and leads disappeared. C-reactive protein and leucocyte count significantly improved directly after initiation of treatment. Because blood cultures remained positive on subsequent days, supplementary investigations were performed. …