Intracardiac "Ghost" Following Implantable Cardioverter-Defibrillator (ICD) Explantation: The Role of Multimodality Imaging in Diagnosis and Management.

Intracardiac "ghosts" are mobile remnants that may persist after transvenous lead extraction (TLE) and can mimic vegetations on transesophageal echocardiography. We report a 55-year-old man who underwent implantable cardioverter-defibrillator (ICD) explantation for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Post-explantation echocardiography revealed a large mobile mass attached to the tricuspid annulus and right atrial appendage. Cardiac magnetic resonance (CMR) imaging demonstrated a nonperfused structure consistent with an organized fibrotic sheath. Serial imaging showed spontaneous regression, although a small pulmonary embolism occurred. This case highlights the echocardiographic features and clinical evolution of a post-explantation "ghost."