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European Journal of Echocardiography Advance Access published online on November 3, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep166
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

A challenging lead endocarditis

C. Mihl, Z. Geyik, E.C. Cheriex and J.M. van Opstal*

Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands

Received 6 June 2009; accepted after revision 13 October 2009.

* Corresponding author. Tel: +31 621 941 644. E-mail address: jm.van.opstal{at}mumc.nl


  Abstract

Pacemaker/implantable cardioverter-defibrillator (ICD) lead endocarditis remains a challenging diagnosis in cardiology. Several parameters can be involved in the clinical path leading to the definite diagnosis. Clinical appearance and physical findings, together with transoesophageal echocardiography and serum levels of inflammatory parameters, are necessary in the workup towards the diagnosis. It is highly unlikely that ICD-lead vegetation is accompanied by positive blood cultures solely. We describe a case of ICD-infected endocarditis with positive blood cultures for Staphylococcus epidermidis without any physical findings or raised inflammatory parameters in serum plasma levels. In this case, three-dimensional echocardiography demonstrated an added value to two-dimensional echocardiography.

Keywords: Endocarditis; Infective; Transoesophageal echocardiograpy; 3D echocardiography; Lead; ICD; Inflammatory; Plasma


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