Magnetic resonance imaging in a patient with temporary external pacemaker

Figure 1. Device implant site and positioning. A: Chest roentgenograph demonstrating the left subclavian location of the device and positioning of the active fixation right ventricular lead. B,C: External location of the implanted device on the chest wall at time of initial examination (B) and after repositioning and placement of gauze to insulate against thermal injury (C).

Figure 2. Brain magnetic resonance imaging. Multifocal bi-hemispheric signal abnormalities with adjacent sulcal effacement (yellow arrows) and mild hemorrhagic conversion (red arrow) are present in the frontal (A), parietal (B), and occipital lobes (C), consistent with an embolic origin. No discrete abscesses visualized.

Figure 3. Cardiac computed tomography. A large hypoattenuated mass consistent with a vegetation (red arrows) is associated with the mechanical aortic valve (A) and protrudes through the valve in systole (B). There is thickening of the mitral-aortic intervalvular fibrosa (yellow arrow), suggestive of perivalvular involvement (C). No abscess was identified. Lead position within the right ventricular apex (green arrows) following magnetic resonance imaging is demonstrated in 4-chamber (D) and modified 2-chamber views (E).