title: Pneumopericardium and pneumothorax after permanent pacemaker implantation.
abstract: 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.
authors.affiliation: Division of Cardiology, Providence VA Medical Center, Brown Medical School, Providence, Rhode Island 02908, USA.
authors.forename: Clifford C
authors.initials: CC
authors.lastname: Sebastian
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
authors.forename: Mark
authors.initials: M
authors.lastname: Shafer
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
authors.forename: Pranav M
authors.initials: PM
authors.lastname: Patel
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011026:Pneumopericardium / Q000209:etiology*; D011030:Pneumothorax / Q000209:etiology*; D019919:Prosthesis Implantation