An elderly man with a presented with a history of fevers for 2 weeks. He had previously undergone pacemaker insertion.
Pacemaker wire endocarditis
Parasternal views were difficult to obtain, with the best views being from the apical window.
The pacemaker wire is seen passing through the tricuspid valve into the right ventricle. On the wire there is a large, mobile, echogenic mass consistent with a vegetation. The mass is best seen in the off axis RV views.
The left ventricle is dilated with poor systolic function.
A large mobile mass on the pacemaker wire in the setting of fevers is highly suggestive of endocarditis.
Infection can complicate any intracardiac device. Pacemaker infections are usually confined to the skin and pacemaker pocket. Pacemaker endocarditis is rare but has a particularly high mortality and generally necessitates the removal of the entire infected pacemaker system (including the wire).