Infected cardiac pacemaker wires demonstrated by Tc-99m labeled white blood cell scintigraphy

Multiple cardiac pacing wires present a potential source of thrombosis and infection within veins and cardiac chambers. A case is presented where persistent infection involved thrombus on cardiac pacing wires in and around the right subclavian and brachiocephalic veins, which proved difficult to localize and treat. Early Ga-67 and Tc-99m labeled white blood cell imaging were negative but, when the latter test was repeated after 5 weeks, the septic focus was identified. Treatment with antibiotic therapy combined with surgical removal of the infected thrombus and both pacing wires was effective in eradicating infection. Failure to demonstrate an infection focus early in the course of the illness may have related to the size of the infection focus; however, in a later phase of the illness, Tc-99m labeled white blood cell imaging proved helpful in localizing focal infection associated with pacemaker wires.