Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Extraction/Removal
D-PO03 - Poster Session III (ID 48)
Poster
D-PO03-098 - When A Seroma Is⋯Not A Seroma (ID 320)
Abstract
Background: Chronic asymptomatic swelling over a CIED, commonly referred to as a seroma, is thought to be benign.
Objective: We report 4 cases of clinical seroma with no clinical signs of infection, eventually proven to be pocket infection.
Results: Case 1: 75 yo man with a DC ICD presented with asymptomatic swelling over device site for 2 years (Fig a) with eventual erosion requiring transvenous lead extraction (TLE). Pocket cultures showed Staphylococcus epidermidis. Case 2: 66 yo man with a DC PPM presented with swelling over the device site (b). Swelling was present for 6 months without change. Ultrasound showed a 6.1x2.8x5.3 cm fluid collection. Pocket exploration revealed purulent fluid positive for Propionibacterium acnes. Case 3: 38 yo man with a CRT-D presented with progressive swelling over device site for 4 years. A tagged WBC scan showed uptake over the generator site (e). Pocket exploration revealed purulent fluid with cultures positive for Propionibacterium acnes. Case 4: A 65 yo man with a DC PPM presented with asymptomatic progressive swelling following blunt trauma to the device site (d). Eventual pocket exploration revealed purulent fluid within the pocket with subsequent negative cultures. All patients underwent successful TLE.
Conclusion: Progressive swelling over CIED sites often represent localized indolent pocket infections and can be misclassified as a benign seroma. Prompt recognition and escalation of diagnostic studies should be considered despite the absence of clinical signs of infection.
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Objective: We report 4 cases of clinical seroma with no clinical signs of infection, eventually proven to be pocket infection.
Results: Case 1: 75 yo man with a DC ICD presented with asymptomatic swelling over device site for 2 years (Fig a) with eventual erosion requiring transvenous lead extraction (TLE). Pocket cultures showed Staphylococcus epidermidis. Case 2: 66 yo man with a DC PPM presented with swelling over the device site (b). Swelling was present for 6 months without change. Ultrasound showed a 6.1x2.8x5.3 cm fluid collection. Pocket exploration revealed purulent fluid positive for Propionibacterium acnes. Case 3: 38 yo man with a CRT-D presented with progressive swelling over device site for 4 years. A tagged WBC scan showed uptake over the generator site (e). Pocket exploration revealed purulent fluid with cultures positive for Propionibacterium acnes. Case 4: A 65 yo man with a DC PPM presented with asymptomatic progressive swelling following blunt trauma to the device site (d). Eventual pocket exploration revealed purulent fluid within the pocket with subsequent negative cultures. All patients underwent successful TLE.
Conclusion: Progressive swelling over CIED sites often represent localized indolent pocket infections and can be misclassified as a benign seroma. Prompt recognition and escalation of diagnostic studies should be considered despite the absence of clinical signs of infection.
