Retained Permanent Epicardial Pacemaker Leads and Lung Abscess: A Diagnostic and Surgical Challenge

Epicardial pacemaker leads are used when transvenous access is contraindicated, but retained leads can rarely result in serious long-term complications.

A 40-year-old male with intravenous drug use, tricuspid valve replacement, and prior epicardial pacemaker implantation presented with hemoptysis. Imaging revealed a left lower lobe lung abscess containing retained epicardial leads, left in situ after incomplete extraction years earlier. He underwent lobectomy and resection of infected leads. Postoperatively, he developed respiratory failure and arrhythmias requiring repeat epicardial pacemaker implantation, but ultimately recovered after rehabilitation.

Lung abscess due to retained permanent epicardial leads is exceedingly rare. This case underscores diagnostic challenges, the morbidity of incomplete lead removal, and the importance of vigilance in patients with prior cardiac device history.

Retained permanent epicardial leads are not biologically inert and may predispose to severe infectious complications. Complete hardware extraction and long-term surveillance are critical.