case_images: PMC1502064_01
case_images: Erosion of the AICD through the skin. Note upper right corner of subcutaneous pocket shows severe erythema with signs of pre-erosion.
case_images: ipej040213-01.jpg
case_images: PMC1502064_01_ipej040213-01.jpg
case_images: F1
case_images: Hg, pulse 86 beats per minute and regular, and respiratory rate of 20 breaths per minute.  He was a well developed, well nourished male sitting comfortably in no distress.  Examination of his neck revealed no JVD at 30 , normal carotid upstrokes without bruits, and no thyromegaly.  His chest was clear and heart examination revealed a non-displaced point of maximal impulse with a normal apical impulse, normal S1 and S2 without an S3 or S4.  His pulse was regular with an apical 2/6 holosystolic murmur with radiation to the axilla.  His anterior chest wall revealed a well healed sternotomy scar with erythema in the left supraclavicular area at the point where his AICD was extruding from his skin without drainage (see Figure 1 and Figure 2).  His abdomen was obese but soft without hepatomegaly.  Neurologically, he was grossly intact.  His lower extremities revealed no edema and distal pulses were intact.  His initial laboratory results were normal including metabolic profile, complete blood count with differential, and coagulation profile.  His chest radiograph revealed clear lungs, normal heart size, and a dual chamber pacemaker/defibrillator with leads in proper position.  His electrocardiogram (ECG) revealed a normal sinus rhythm with right bundle branch block, left posterior fascicular block, and an old inferior infarct. 
case_images: Close up examination of AICD eroding through the skin.
case_images: ipej040213-02.jpg
case_images: PMC1502064_01_ipej040213-02.jpg
case_images: F2
case_images: Hg, pulse 86 beats per minute and regular, and respiratory rate of 20 breaths per minute.  He was a well developed, well nourished male sitting comfortably in no distress.  Examination of his neck revealed no JVD at 30 , normal carotid upstrokes without bruits, and no thyromegaly.  His chest was clear and heart examination revealed a non-displaced point of maximal impulse with a normal apical impulse, normal S1 and S2 without an S3 or S4.  His pulse was regular with an apical 2/6 holosystolic murmur with radiation to the axilla.  His anterior chest wall revealed a well healed sternotomy scar with erythema in the left supraclavicular area at the point where his AICD was extruding from his skin without drainage (see Figure 1 and Figure 2).  His abdomen was obese but soft without hepatomegaly.  Neurologically, he was grossly intact.  His lower extremities revealed no edema and distal pulses were intact.  His initial laboratory results were normal including metabolic profile, complete blood count with differential, and coagulation profile.  His chest radiograph revealed clear lungs, normal heart size, and a dual chamber pacemaker/defibrillator with leads in proper position.  His electrocardiogram (ECG) revealed a normal sinus rhythm with right bundle branch block, left posterior fascicular block, and an old inferior infarct. 