Cardiovasc Imaging Asia.  2022 Oct;6(4):110-113. 10.22468/cvia.2022.00136.

An Unexpected Mass in a Patient With a Left Ventricular Assist Device

• Shariff REFR
• Beng KH
• Yuen BT
• Sin TY
• Ghazi AM

• KMID: 2534909
• DOI: http://doi.org/10.22468/cvia.2022.00136

Abstract

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.

Keyword

Left ventricular assist device; Pump pocket infection; Driveline infection; PET-CT imaging; Case report