[Pacemaker-induced infection: diagnosis by multi-plane transesophageal echocardiography]

We report the identification by multiplane transesophageal echocardiography of a vegetation on a permanent pacemaker lead in a patient with persistent bacteriemia. The lesion could not be visualized with transthoracic echocardiography. The diagnosis of vegetation was based on the visualization of a freely highly mobile mass attached to the pacemaker lead, with different echogenicity from the lead. The entire pacing system was surgically removed through a right atrial approach, and inspection confirmed pacemaker lead vegetation. We conclude that transesophageal echocardiography should be considered to investigate suspected pacemaker lead infection in patients with negative transthoracic echocardiography.