A novel diagnostic approach to a mass on a device lead

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Presentation transcript:

A novel diagnostic approach to a mass on a device lead David Chang, MD, James Gabriels, MD, Saaron Laighold, MD, Alex K. Williamson, MD, Haisam Ismail, MD, Laurence M. Epstein, MD HeartRhythm Case Reports Volume 5, Issue 6, Pages 306-309 (June 2019) DOI: 10.1016/j.hrcr.2019.03.001 Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 1 Transesophageal echocardiography–guided biopsy of thrombus on a device lead. A–C: Bicaval transesophageal echocardiogram views of the thrombus on the right atrial lead. The asterisk denotes the thrombus. Blue arrows point to the lead. The red arrow in panel C is the bioptome in close proximity to the thrombus. D: Intracardiac mass, hematoxylin–eosin stain, ×200. Haphazard admixture of erythrocytes, fibrin, and neutrophils, consistent with thrombus. IVC = inferior vena cava; RA = right atrium; SVC = superior vena cava. HeartRhythm Case Reports 2019 5, 306-309DOI: (10.1016/j.hrcr.2019.03.001) Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 2 Transesophageal echocardiography–guided biopsy of a vegetation on a device lead. A–C: Midesophageal 4-chamber views at 0 degrees of the vegetation on the right ventricular lead. The asterisk denotes the vegetation. Blue arrows point to the lead. The red arrow in panels B and C is the bioptome sampling the vegetation. D: Mass on right ventricular lead, hematoxylin–eosin, ×40. Aggregates of fibrin admixed with neutrophils and basophilic debris with few erythrocytes, consistent with vegetation. Special stains (Gram, periodic acid–Schiff, and Gomori methenamine silver) for organisms were negative. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; TV = tricuspid valve. HeartRhythm Case Reports 2019 5, 306-309DOI: (10.1016/j.hrcr.2019.03.001) Copyright © 2019 Heart Rhythm Society Terms and Conditions