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Takeo Fujino, Taiki Higo, Yoshihisa Tanoue, Tomomi Ide, FDG-PET/CT for driveline infection in a patient with implantable left ventricular assist device, European Heart Journal - Cardiovascular Imaging, Volume 17, Issue 1, January 2016, Page 23, https://doi.org/10.1093/ehjci/jev234
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The patient in this case was a 41-year-old man who had undergone implantable left ventricular assist device (LVAD) implantation (DuraHeart, Terumo, Japan) 8 months before due to refractory heart failure caused by hypertensive heart disease. The patient had suffered from epigastric pain for 1 week, and a plain computed tomography (CT) scan did not show any causal diseases. As it was not possible to perform a contrast-enhanced CT scan because of renal impairment, an 18F-fluorodeoxyglucose (FDG)-positive emission tomography (PET)/CT scan was performed in order to identify the focus of the pain. Abnormal FDG uptake was observed around the driveline (pretreatment, left panel), and we therefore diagnosed a driveline infection. At the same time, the patient also suffered from high-grade fever and serum C-reactive protein (CRP) level was elevated to 4.89 mg/dL. Intravenous administration of ciprofloxacin was immediately initiated, taking into consideration the drug sensitivity of Pseudomonas aeruginosa at the driveline exit site. After the antibiotic treatment for 1 month, CRP level became negative. And, FDG-PET/CT showed significantly decreased FDG uptake (maximum standardized uptake value; 6.20 to 2.54) around the driveline (post-treatment, right panel).