Publish in this journal
Journal Information
Vol. 71. Issue 1.
Pages 43 (January 2018)
Image in cardiology
DOI: 10.1016/j.rec.2017.05.006
Full text access
Role of PET/angio-CT in the Evaluation of Intracardiac Devices
Papel de la PET/angio-TC para evaluar dispositivos intracardiacos
Julián Rodríguez-Garcíaa,
Corresponding author

Corresponding author:
, María N. Pizzia,b, Albert Roqueb,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
This item has received
(Daily data update)
Article information
Full Text
Download PDF
Figures (2)
Full Text

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 1A, arrows). Anatomic-metabolic fusion images excluded pathologic uptake at the generator and lead (Figure 1B and 1C, arrows), whereas mild, homogeneous hypermetabolism was seen around the generator (Figure 1B, 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 2A, 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 2B-2D, 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.

Copyright © 2017. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.