Hemopneumothorax due to subacute right ventricular perforation by a pacemaker lead with subtle clinical presentation

Subacute right ventricular perforation by a pacemaker lead is a rare complication. Although occasionally asymptomatic, complicated cases are usually evidently symptomatic. Here, we report a 70-year-old man presented with mild left-sided chest pain three days after permanent pacemaker implantation. Suspected of ventricular perforation by the pacemaker lead on chest X-ray, device interrogation revealed non-corroborative parameters. This warranted a computed tomography (CT) scan, which confirmed the diagnosis, detected hemopneumothorax, and helped plan surgical intervention. The patient underwent surgical management with the placement of an epicardial pacemaker lead and was discharged after five days. Our case illustrates a rare report of subtle clinical presentation in a patient with subacute right ventricular perforation by a pacemaker lead complicated by hemopneumothorax. It further recapitulates the role of CT scan in providing definitive diagnostic information in managing such a patient. Anticipation of such a presentation is essential for primary care physicians, who are often a first contact point for a patient in the community. This requires a high index of suspicion in such patients presenting with minimal symptoms. Early recognition and timely referral by a family physician may prevent untoward consequences of device-related complications.