Ultra-Chronic ICD Lead Perforation: A Case of an FDG-Avid Pericardial Effusion

Chronic implantable cardioverter-defibrillator (ICD) lead perforation is a rare but serious complication, often diagnosed via computed tomography. A 51-year-old man with cardiac sarcoidosis and a dual-chamber ICD presented with progressive chest pain. A routine 18F-fluoro-2-deoxy-2-D-glucose (FDG) positron emission tomography/computed tomography scan revealed an FDG–avid cystic lesion, later confirmed as an inflammatory pericardial effusion with gross ICD lead perforation. Echocardiography showed right ventricular compression. He had percutaneous lead extraction using a laser sheath, with symptom resolution. This case, with a 17-year dwell time, represents the longest documented chronic perforation successfully treated percutaneously, highlighting an unusual presentation in a patient with cardiac sarcoidosis.