Background: Hardware infection is the most serious complication of implantable cardiac devices, as device extraction is required in most of these cases. Seroma of device pocket may imitate device infection. The objectives of this study were to review cases of device seroma, their incidence, clinical presentation, and their management.
Methods and results: Among 608 new cardiac device implantation procedures performed in our institution, four cases of device seroma were identified making an incidence of 1/1000 per year.These devices included two pacemakers and two CRTD systems. Patient's age ranged 51-75 years. Two cases were on warfarin, while the other two received aspirin prior to the implantation.
Two patients were diabetic. The appearance of Seroma was 9,10,12, and 31 day after implantation procedure.
Major complain was pain and swelling of device pocket, without fever, or chills. On physical examination the pocket skin was red, tender, and warm. Blood tests demonstrated normal CRP levels, and normal WBC count without left shift.
Intra-operative findings revealed tens pocket full of thick yellow fluid which has high WBC count and PMN predominance. Fascia and deep muscles were healthy without friable or necrotic tissue. Fluid, pocket tissue and hardware samples demonstrated negative gram stain, bacterial culture, or bacterial DNA. Silk suture was the only predisposing factor for inflammation.
Management included drainage of pocket fluid, removal of silk sutures, and administration of one or two antibiotic doses until confirmation of negative cultures. There was no need for hardware removal.
Conclusion: Cardiac device seroma is an uncommon cause of pocket inflammation. Unlike pocket infection, there is no need for prolonged antibiotic therapy or hardware extraction. Diagnosis is based on clinical, intra operative, and laboratory findings. Silk sutures appear to be the primary nidus for inflammation process.
