Pulsatile abdominal mass is not always leaking aneurysm!
An 80-year-old male, who presented with a history of unprovoked collapse, was found to have a visible pulsation in the central upper abdomen, which disappeared on raising his arms above his shoulder ('head and shoulder' technique). There was no tenderness noted over the pulsation. He had a ventricular demand inhibited pacemaker inserted 3 weeks ago for a significant bradycardia with atrial fibrillation. His ECG showed heart rate of 32 bpm with underlying atrial fibrillation. No pacing spikes noted. His chest x-ray confirmed displacement of pacing lead into the right subclavian vein. It caused stimulation of phrenic nerve resulting in rhythmical diaphragmatic contraction. He later had his pacemaker re-inserted with no more collapses.
Department of Acute Medicine, Stepping Hill Hospital, Stockport, Cheshire, UK. syedviqarahmed@hotmail.com
Syed Viqar
SV
Ahmed
Philip Anthony
PA
McMillan
Chaminda
C
Jayawarna
D000005:Abdomen; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013577:Syndrome