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Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report
INTRODUCTION AND IMPORTANCE: Right ventricular pacemaker lead perforation is a rare but well documented complication of pacemaker implantation. Lead perforation can cause an array of symptoms ranging from none to hemodynamic instability and tamponade. In previously reported cases, lead perforation h...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8924622/ https://www.ncbi.nlm.nih.gov/pubmed/35286979 http://dx.doi.org/10.1016/j.ijscr.2022.106924 |
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author | Topoluk, Natasha Kieffer, Hannah Sutter, Heather Fayn, Evgueni Pagel, Paul S. Almassi, G. Hossein |
author_facet | Topoluk, Natasha Kieffer, Hannah Sutter, Heather Fayn, Evgueni Pagel, Paul S. Almassi, G. Hossein |
author_sort | Topoluk, Natasha |
collection | PubMed |
description | INTRODUCTION AND IMPORTANCE: Right ventricular pacemaker lead perforation is a rare but well documented complication of pacemaker implantation. Lead perforation can cause an array of symptoms ranging from none to hemodynamic instability and tamponade. In previously reported cases, lead perforation has always been able to be confirmed by imaging, with computed tomography (CT) scan considered to be the gold standard diagnostic imaging modality. CASE PRESENTATION: An 80-year-old male underwent uncomplicated implantation of a dual chamber pacemaker for sick sinus syndrome as an outpatient. Thirty-nine days later, the patient presented to the emergency department complaining of new-onset, left-sided, pleuritic chest pain. He was found to have unilateral hemothorax and abnormal pacemaker lead interrogation. Pacemaker lead perforation was suspected but not confirmed with imaging. Lead perforation was only identified after surgical exploration. CLINICAL DISCUSSION: This patient had multiple risk factors for pacemaker lead perforation. However, imaging, including CT scan was unable to confirm perforation. The presence of an otherwise unexplained left hemothorax strongly suggested that surgical intervention was indicated. The lead perforation was subsequently confirmed with subxiphoid exploration of the pericardial space. The mechanism of lead perforation resulting in hemothorax in this case is not straight forward, as no direct communication between the pericardial and pleural spaces was identified. However, previously described visceral pericardial self-sealing may contribute to the small pericardial accumulation described herein. CONCLUSION: This patient's presentation and clinical course underscore the importance of maintaining a high index of suspicion for pacemaker lead perforation despite a lack of confirmation with imaging. |
format | Online Article Text |
id | pubmed-8924622 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-89246222022-03-17 Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report Topoluk, Natasha Kieffer, Hannah Sutter, Heather Fayn, Evgueni Pagel, Paul S. Almassi, G. Hossein Int J Surg Case Rep Case Report INTRODUCTION AND IMPORTANCE: Right ventricular pacemaker lead perforation is a rare but well documented complication of pacemaker implantation. Lead perforation can cause an array of symptoms ranging from none to hemodynamic instability and tamponade. In previously reported cases, lead perforation has always been able to be confirmed by imaging, with computed tomography (CT) scan considered to be the gold standard diagnostic imaging modality. CASE PRESENTATION: An 80-year-old male underwent uncomplicated implantation of a dual chamber pacemaker for sick sinus syndrome as an outpatient. Thirty-nine days later, the patient presented to the emergency department complaining of new-onset, left-sided, pleuritic chest pain. He was found to have unilateral hemothorax and abnormal pacemaker lead interrogation. Pacemaker lead perforation was suspected but not confirmed with imaging. Lead perforation was only identified after surgical exploration. CLINICAL DISCUSSION: This patient had multiple risk factors for pacemaker lead perforation. However, imaging, including CT scan was unable to confirm perforation. The presence of an otherwise unexplained left hemothorax strongly suggested that surgical intervention was indicated. The lead perforation was subsequently confirmed with subxiphoid exploration of the pericardial space. The mechanism of lead perforation resulting in hemothorax in this case is not straight forward, as no direct communication between the pericardial and pleural spaces was identified. However, previously described visceral pericardial self-sealing may contribute to the small pericardial accumulation described herein. CONCLUSION: This patient's presentation and clinical course underscore the importance of maintaining a high index of suspicion for pacemaker lead perforation despite a lack of confirmation with imaging. Elsevier 2022-03-09 /pmc/articles/PMC8924622/ /pubmed/35286979 http://dx.doi.org/10.1016/j.ijscr.2022.106924 Text en https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Topoluk, Natasha Kieffer, Hannah Sutter, Heather Fayn, Evgueni Pagel, Paul S. Almassi, G. Hossein Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
title | Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
title_full | Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
title_fullStr | Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
title_full_unstemmed | Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
title_short | Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
title_sort | left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8924622/ https://www.ncbi.nlm.nih.gov/pubmed/35286979 http://dx.doi.org/10.1016/j.ijscr.2022.106924 |
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