FDG PET/CT in the Localization of Cardiac Device Infections: Discriminating Between Left Ventricular Assist Device and Implantable Cardioverter Defibrillator Infection

Infections related to cardiac assist devices pose significant diagnostic challenges, especially in patients with multiple implanted systems. A 45-year-old male was reported with both a left ventricular assist device (LVAD) and an implantable cardioverter defibrillator (ICD) evaluated for persistent driveline discharge despite extended antibiotic therapy. Serial cultures were negative for common LVAD pathogens, whereas Mycobacterium tuberculosis complex positivity in pleural fluid and a progressive purified protein derivative response supported concomitant tuberculosis infection. The scan revealed heterogeneous FDG uptake along the LVAD driveline, consistent with active infection, and homogeneous uptake around the pump, interpreted as sterile inflammation likely due to surgical adhesives. No abnormal uptake was observed around the ICD. These findings enabled accurate localization of the infection and prevented unnecessary device removal. Fluorodeoxyglucose (FDG) PET/CT proved valuable in differentiating infectious and non-infectious processes in coexisting cardiac devices, guiding focused surgical and antimicrobial management. This case underscores the growing clinical utility of FDG PET/CT in delineating complex cardiac device infections and its influence on tailored therapeutic decision-making in patients with mechanical circulatory support. Cite this article: İşleyen Çolak E, Bilgiç S, Alper E. FDG PET/CT in the localization of cardiac device infections: discriminating between left ventricular assist device and implantable cardioverter defibrillator infection. Cerrahpaşa Med J. 2026; 50: 0095. doi: 10.5152/cjm.2026.25095