An unusual defibrillator lead-associated echodensity.

A 62-year-old woman with nonischemic cardiomyopathy underwent the prophylactic implantation of a single-chamber implantable cardioverter-defibrillator. The first rib extrathoracic axillary vein approach under fluoroscopic guidance was used for vascular access. The system comprised a model 6935 single-coil lead and a model D314DRG generator (Medtronic, Minneapolis, MN). The lead was implanted in the right ventricular apex and was affixed to the pectoral tissue by using a suture sleeve in the usual fashion. One year later, transthoracic echocardiography was performed for the evaluation of malaise and worsening dyspnea on exertion. It revealed the presence of a mobile echodensity associated with the lead in the vicinity of the tricuspid valve, suspective of vegetation or thrombus. Subsequent transesophageal echocardiography showed similar findings (Figure 1 and