Subacute pacemaker lead migration with cardiac perforation and extracardiac extension into lung parenchyma with associated pneumothorax

Figures

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  Fig. 1. Posteroanterior (A) and lateral (B) radiograph of the chest. The dual chamber pacemaker generator is seen in the left upper chest wall. Pacemaker leads are intact. The atrial lead appears to be in placed in the right atrium. On frontal posteroanterior projection the tip of the right ventricular lead appears to project slightly beyond the cardiac border which is not evident on lateral view (yellow arrow). Small left apical pneumothorax is present.

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  Fig. 2. Gated CT angiogram of the chest, showing the right ventricular lead migration through the (A) and (B) interventricular septum towards the apex, (C) through the apex, and (D) into the left upper lobe (yellow arrow).

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  Fig. 3. Lung window of the same gated CT angiogram of the chest, showing the left-sided apical pneumothorax. The right ventricular lead can be seen traversing through the pericardium and passing into the left upper lobe of the lung (yellow arrow).

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  Fig. 4. Multiplanar reconstructions from the above gated CT angiogram of the chest, showing the course of the right ventricular lead (yellow arrow) in coronal plane (A), sagittal plane (B), and along the plane of the interventricular septum (C).