title: Late pacemaker lead tip perforation documented by chest CT.
abstract: Late cardiac perforation by a right ventricular (RV) pacemaker lead may be a challenge to diagnose. Echocardiography often will not adequately demonstrate lead tip migration, but chest computed tomography (CT) readily identifies the lead and tip location. A patient presented one month after dual-chamber pacemaker implantation with fever, sepsis and failure of RV pacer lead capture. Echocardiography demonstrated vegetations on the RV lead and a pericardial effusion, but the lead tip location could not be identified. CT identified the tip as having migrated through the pericardium into the anterior mediastinum. These complimentary echo and CT findings helped make a diagnosis and direct patient therapy.
authors.affiliation: Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana. njain@lsuhsc.edu.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Jain
authors.affiliation: Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Vijay
authors.initials: V
authors.lastname: Ravipati
authors.affiliation: Heart Clinic of Louisiana, Marrero, Louisiana.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Kerut
mesh_terms: D003937:Diagnosis, Differential; D004567:Electrodes, Implanted; D006801:Humans; D008482:Mediastinum / Q000000981:diagnostic imaging* / Q000293:injuries*; D010138:Pacemaker, Artificial; D013902:Radiography, Thoracic / Q000379:methods*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: CT; Staphylococcus aureus; echocardiography; purulent pericarditis