Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:43 - Vol. 71 Num.01 DOI: 10.1016/j.rec.2017.05.006

Role of PET/angio-CT in the Evaluation of Intracardiac Devices

Julián Rodríguez-García a,, María N. Pizzi a,b, Albert Roque b,c

a Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
c Servicio de Radiología, Hospital Universitari Vall d’Hebron, Barcelona, Spain

Article

A 69-year-old man was admitted for fever 2 weeks after implantation of an automatic defibrillator for primary prevention of ischemic cardiomyopathy. He had a hematoma and inflammation at the generator pocket, and acute-phase reactants were elevated. Transesophageal echocardiography ruled out valvular and device lead vegetations. Cultures of blood and the hematoma material were negative. Nonetheless, the fever persisted, and to complement the diagnosis we performed 18F-FDG positron emission tomography combined with cardiac computed tomography angiography (PET/CT angiography).

Prospective electrocardiogram (ECG)-triggered cardiac CT angiography showed no vegetations/thrombi at the lead (Figure 1, arrows). Anatomic-metabolic fusion images excluded pathologic uptake at the generator and lead (Figure 1, arrows), whereas mild, homogeneous hypermetabolism was seen around the generator (Figure 1, arrow), attributable to the recent postoperative changes.

Figure 1.

CT angiography also showed wall thickening of both atria and reticulation of the interatrial fat (Figure 2, arrows). The fusion images depicted marked hypermetabolism of the atrial walls, interatrial septum, pericardium, and tissue surrounding the superior vena cava, together with signs of pericarditis (pericardial effusion with focal 18F-FDG uptake) (Figure 2, arrows). The final diagnosis was inflammatory response syndrome following device implantation, with pericarditis, and atrial wall and perivascular involvement. Anti-inflammatory treatment was started, the condition resolved, and device infection was ruled out.

Figure 2.

This case illustrates the usefulness of PET/CT angiography to confirm or exclude inconclusive cases of intracardiac device infection and provide alternative diagnoses, such as postimplantation inflammatory response syndrome.

Corresponding author: julianrodriguez312@gmail.com

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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