Pneumopericardium and pneumothorax after permanent pacemaker implantation.
We present a patient with chronic obstructive pulmonary disease who developed discomfort 2 days after dual-chamber pacemaker implantation via the left cephalic vein approach. The pacer was placed with active-fixation leads without obvious complications. A computed tomography (CT) scan taken in the emergency room showed right pneumothorax and associated pneumopericardium without pneumomediastinum. A three-dimensional reconstruction of CT images confirmed the atrial lead protruding into the pleural space. This lead likely ruptured a bulla causing a pneumothorax followed by pneumopericardium through a pleuro-pericardial communication. Chest tube placement relieved both pneumothorax and pneumopericardium without the need for atrial lead extraction.
Sebastian
Clifford C
CC
Division of Cardiology, Providence VA Medical Center, Brown Medical School, Providence, Rhode Island 02908, USA.
Wu
Wen-Chih
WC
Shafer
Mark
M
Choudhary
Gaurav
G
Patel
Pranav M
PM
D000368:Aged; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011026:Pneumopericardium / Q000209:etiology*; D011030:Pneumothorax / Q000209:etiology*; D019919:Prosthesis Implantation