Diagnosis of pacemaker lead infection using transoesophageal echocardiography: a case report.

INTRODUCTION Vegetative lead infection is an uncommon complication of permanent pacemaker implantation. The diagnosis is difficult using conventional imaging methods. CLINICAL PICTURE An elderly Indian woman with a history of diabetes mellitus developed Staphylococcus aureus infection after implementation of a permanent pacemaker. Following a non-diagnostic transthoracic echocardiogram, transoesophageal echocardiography was performed and showed a large vegetative mass attached to the pacemaker lead within the right atrium. TREATMENT The pacemaker was removed and intravenous vancomycin administered for six weeks. OUTCOME She was discharged well but demised two months later from a second episode of septicaemia. CONCLUSIONS Pacemaker lead infection remains a challenging management problem. Transoesophageal echocardiography can facilitate its diagnosis.