CTICasesMediastinal Pocket Infection with Empyema-like Cavity after LVAD Explant and Heart Transplant
[...]. Mediastinal Pocket Infection with Empyema-like Cavity after LVAD Explant and Heart Transplant. CTICases. Published October 23, 2026. https://cticases.com/c/tpuwn
Imaging findings
After LVAD removal and heart transplant, a cavity with a fluid level sits at the cardiac apex with high-attenuation material layering in its dependent part. Gas tracks along the front of the pericardium toward a sternal abscess that contains gas and points forward. The cavity is in the region where the apical LVAD cannula sat.
Key takeaways
After LVAD explant, the apical pocket can become infected and spread to the mediastinum and sternum, so a new cavity in that location should prompt the device pocket as the likely source. Distinguishing a pleural from a mediastinal collection is difficult on imaging, and the pocket is often the culprit. High-density material in a dependent cavity can be retained debris or talc rather than clot.
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