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An Unexpected Mass in a Patient With a Left Ventricular Assist Device
Raja Shariff Raja Ezman Faridz,Beng Koh Hui,Ting Yuen Beh,Yee Sin Tey,Mohd Ghazi Azmee 아시아심장혈관영상의학회 2022 Cardiovascular Imaging Asia Vol.6 No.4
Left ventricular assist devices (LVAD) have helped improve survival, functional status, and quality of life for end-stage heart-failure patients, worldwide. Unfortunately, the risk of complications associated with such devices, including infections, has increased with improved survival. We report a unique case of pump pocket infections (PPI) and collection, diagnosed using multi-modality cardiovascular imaging in a young male patient implanted with a HeartWare LVAD. He had multiple admissions in the past for driveline infections (DLI). Transthoracic echocardiography revealed a 1.4×4.6-cm hyperechoic mass. An 18F-FDG PET-CT scan was performed revealing multiple foci of hypermetabolism seen along the driveline and pump, as well as from a lesion with high radiotracer uptake anterior to the right ventricle, suggesting collection. The patient underwent extensive wound debridement and prolonged intravenous antibiotics, followed by life-long oral antibiotics. Although uncommon, following the current trend in preferential use of centrifugal pumps, PPI remains a possibility, especially in the presence of chronic DLI. Our case highlights the value of multi-modality imaging, including PET-CT imaging, in managing LVAD-related infections, as it may alter the course of subsequent management.
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