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An Unusual Appearance of Fibrin Sheaths after Implantable Cardioverter‐Defibrillator Removal Because of Infective Endocarditis

We report the case of a 26-year-old woman with dilated cardiomyopathy bearing an implantable cardioverter-defibrillator (ICD) who developed infective endocarditis. Transesophageal echocardiography (TEE) (Philips iE33, Advanced Diagnostics, Palo Alto, CA, USA) showed a vegetation attached to an electrode lead with a typical morphology and motion (Fig. 1, arrow, see movie clip S1). The ICD and 2 electrode leads were removed. A new TEE (Fig. 2, arrows, see movie clip S2) showed a bright linear calcific density in the superior vena cava (SVC), which was suggestive of a retained fibrin “sleeve.” A computed tomography scan (Aquilon, Toshiba Medical Systems, Tokyo, Japan) with contrast (Fig. 3, arrow) showed the filling defect caused by “fibrin