Key result
18FDG PET/CT identifies pacemaker lead infection causing recurrent PE that resolves after surgical removal.
Pacemaker lead infection can be an unexpected cause of recurrent pulmonary embolism, and 18FDG PET/CT is a valuable diagnostic tool for identifying it.
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Recurrent PE may stem from undetected pacemaker lead infection; this case leaves open routine 18FDG PET/CT use pending prospective data.
Recurrent pulmonary embolism (PE) is uncommon. We report a 39-year-old man with a pacemaker who developed recurrent PEs while receiving rivaroxaban, warfarin, and therapeutic enoxaparin. Evaluation for autoimmunity and thrombophilia was negative. Each episode was preceded by fever, malaise, and myalgia. During admission, 18-fluorodeoxyglucose positron emission tomography–computed tomography (18FDG PET/CT) showed focal uptake (maximum standardized uptake value, 2.3) along the right-ventricular pacemaker lead, suggesting device-related infection or thrombosis. Transvenous extraction failed; subsequently, surgical removal was performed. Cultures remained negative. This case highlights pacemaker-associated infection as a treatable cause of septic embolization and underscores the diagnostic value of 18FDG PET/CT in recurrent PE.
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Salibe-Filho et al. (2026) studied this question. Pacemaker lead infection detected by 18FDG PET/CT caused recurrent pulmonary embolism unresponsive to anticoagulation, resolved after surgical lead removal.
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