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Physical appearance of the chest before subcutaneous implantable cardioverter-defibrillator system removal. Purulent drainage from the subxiphoid incision is shown. There is moderate swelling by the device pocket. The sub-suprasternal notch (superior) incision is intact, but erythema is noted.
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In addition, superficial ulceration with purulent discharge was noted at the prior subxiphoid incision site (Figure 1).
Computed tomographic scan of the chest showing device pocket infection. A rim-enhancing fluid collection (11.4 x 5.1 x 10.1 cm) surrounding the subcutaneous implantable cardioverter-defibrillator generator is shown. A small pocket of air within the fluid collection is also shown. S-ICD = subcutaneous implantable cardioverter-defibrillator.
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A computed tomographic scan of the chest demonstrated a rim-enhancing fluid collection (11.4 x 5.1 x 10.1 cm) surrounding the S-ICD generator suspicious for abscess with inflammatory changes tracking along the ICD lead (Figure 2).
Still image from the video recording during device explantation. More than 200 cm3 of purulent fluid was drained upon incision of the device pocket site.
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More than 200 cm3 of purulent fluid was removed and sent for culture, which eventually grew out methicillin-sensitive S aureus (Figure 3).