Panagiotis Margos N, Nikolaos Margos P, St Georgia Goranitou, Athanasios Kranidis I
1st Cardiology Department, General Hospital of Nikea Ag. Panteleimon, Mantouvalou 3, Nikea Attitkis, Greece.
Eur Heart J Case Rep. 2018 May 26;2(2):yty063. doi: 10.1093/ehjcr/yty063. eCollection 2018 Jun.
Thrombosis of the intracardiac part of a permanent pacemaker lead, which is usually detected during a routine transthoracic echocardiographic examination, can be totally asymptomatic. The differential diagnosis between intracardiac lead thrombosis and vegetation is crucial, especially in febrile patients, as these two situations are totally different regarding prognosis and treatment.
We describe the case of an 85-year-old patient with a dual chamber pacemaker (DDDR) due to complete heart block, who was admitted twice, within 2 years, with vegetation-like masses attached to the ventricular lead of the pacemaker. Infective endocarditis was not documented (diagnostic criteria were not fulfilled), although clinical suspicion was high during both hospitalizations. Masses resolved under applied treatment (anticoagulation) in both cases.
Differential diagnosis between lead thrombosis and vegetation was ambiguous in both hospitalizations. Τhe F-fluorodeoxyglucose positron emission tomography/computed tomography during the 2nd hospitalization excluded a possible inflammatory origin of the masses.
永久性起搏器导线心内部分的血栓形成通常在常规经胸超声心动图检查时被发现，可能完全没有症状。心内导线血栓形成与赘生物的鉴别诊断至关重要，尤其是在发热患者中，因为这两种情况在预后和治疗方面完全不同。
我们描述了一例85岁因完全性心脏传导阻滞植入双腔起搏器（DDDR）的患者，该患者在2年内两次因起搏器心室导线上附着有赘生物样肿块入院。尽管两次住院期间临床高度怀疑，但未记录到感染性心内膜炎（未满足诊断标准）。在两种情况下，肿块均在应用治疗（抗凝）后消退。
两次住院期间，导线血栓形成与赘生物的鉴别诊断均不明确。第二次住院期间的F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描排除了肿块可能的炎症起源。
