False positive result of positron emission tomography in a patient with suspected defibrillator system infection

Abstract

The infection of an implanted pacemaker or defibrillator is often difficult to diagnose. Positron emission tomography-computerized tomography (PET-CT) has recently been shown to be of great interest in this difficult clinical setting. We report the case of a patient with suspected implantable cardioverterdefibrillator (ICD) infection. Because of 18 F-fluorodeoxyglucose (FDG) uptakes on different portions of the ICD, complete extraction of the ICD generator and lead was performed. Bacteriological samples remained sterile. FDG PET-CT, which appears to be a promising tool for the management of patients with suspected pacemaker/ICD infection, does not have a perfect specificity to detect lead infection, and should not be used alone to diagnose difficult cases of implantable cardiac device infection. <Learning objective: The aim of this case is to bring to light the necessity of specifying the place of PET-CT and its limits for the diagnosis of endocarditis on pacemaker/ICD devices.>