Contralateral pneumothorax, pneumomediastinum, and pneumopericardium after dual-chamber pacemaker implantation

Q3 Medicine

Indian Pacing and Electrophysiology Journal Pub Date : 2025-05-01 DOI:10.1016/j.ipej.2025.05.005

Mariana Pereira Santos , André Alexandre , Maria João Sousa , Severo Torres

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引用次数: 0

Abstract

We present a rare case of a 79-year-old man who developed contralateral pneumothorax, pneumomediastinum, and pneumopericardium following dual-chamber pacemaker implantation for symptomatic second-degree atrioventricular block. The procedure itself was uneventful, with appropriate lead placement and good electrical parameters.

However, 30 minutes post-procedure, the patient developed right-sided pleuritic chest pain and dyspnea. Imaging revealed a right-sided pneumothorax, pleural effusion, pneumomediastinum, and pneumopericardium. A chest drain was inserted due to the significant pneumothorax volume, leading to symptom resolution. Electrocardiographic changes and inflammatory marker elevation suggested pericarditis, which was successfully treated with ibuprofen and colchicine. The patient was discharged after 13 days and remained stable at a 1-year follow-up.

The suspected mechanism of injury was atrial lead perforation, although other causes, such as pleural puncture or superior vena cava injury, were considered. Management of such cases varies, with lead revision being unnecessary in this patient due to stable pacing parameters. This case highlights an unusual complication of pacemaker implantation and underscores the importance of prompt diagnosis and individualized management.

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双腔起搏器植入后对侧气胸、纵隔气肿和心包膜气肿。

我们报告一个罕见的病例，一位79岁的男性在双室起搏器植入后出现对侧气胸、纵隔气肿和心包膜气肿。过程本身是平淡无奇的，适当的引线放置和良好的电气参数。然而，手术后30分钟，患者出现右侧胸膜炎胸痛和呼吸困难。影像显示右侧气胸、胸腔积液、纵隔气和心包气。由于气胸体积大，我们插入胸腔引流管，导致症状缓解。心电图变化和炎症标志物升高提示心包炎，布洛芬和秋水仙碱治疗成功。患者于13天后出院，并在1年随访中保持稳定。虽然其他原因，如胸膜穿刺或上腔静脉损伤也被考虑，但可能的损伤机制是心房导联穿孔。这类病例的处理方法各不相同，由于起搏参数稳定，该患者无需导联翻修。本病例强调了起搏器植入的罕见并发症，并强调了及时诊断和个体化治疗的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Pacing and Electrophysiology Journal Medicine-Cardiology and Cardiovascular Medicine

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

61 days

期刊介绍： Indian Pacing and Electrophysiology Journal is a peer reviewed online journal devoted to cardiac pacing and electrophysiology. Editorial Advisory Board includes eminent personalities in the field of cardiac pacing and electrophysiology from Asia, Australia, Europe and North America.