Contralateral pneumothorax and pneumopericardium after dual-chamber pacemaker implantation: Mechanism, diagnosis, and treatment

Pan pneumo: an unusual complication following pacemaker implantation

Implantation of cardiac devices is usually considered to be a safe procedure. Rare complications, such as pneumothorax, may occur after the procedure. The association with pneumopericardium or pneumomediastinum is even more uncommon. We present the case of a patient in his 70s, on haemodialysis, admitted for complete atrioventricular block. He underwent implantation of a dual-chamber pacemaker. He presented with chest pain the day after implantation. Chest CT scan revealed a pneumothorax associated with a pneumopericardium and pneumomediastinum 'pan pneumo', due to an atrial perforation. We opted for a conservative management strategy. Repeat CT scan of the chest 8 days after the procedure showed a complete resorption of the 'pan pneumo'. The objective of this case report is to describe this rare complication and provide further insight into its management, particularly in the absence of specific guidelines.

Traumatic Right Atrium Perforation Causing a Pneumothorax and Pneumopericardium, Treated Conservatively

Pacemaker insertion is a daily occurrence in the United States of America, and it is a relatively common procedure; however, complications can occur. One common complication includes the development of a pneumothorax; however, there are rare instances where patients can develop a pneumopericardium as well. We present a case of a patient who underwent dual chamber pacemaker implantation complicated by a pneumothorax and left-sided pneumopericardium, which is a rare finding. This patient initially presented with syncopal episodes and a dual chamber pacemaker was inserted; however, not long after, the patient developed pericarditis and was found to have a pneumothorax and a pneumopericardium. In these cases, patients can be treated with chest tube insertion, lead extraction, or even conservatively, depending on the patient's clinical status. Various reasons exist for the development of a pneumothorax and pneumopericardium; however, the guidelines on management are still unclear and require further study. In our patient, his pneumothorax and contralateral pneumopericardium were treated conservatively with stable follow-up post-hospitalization.

Very late-onset atrial lead perforation leading to pneumopericardium

BACKGROUND

Atrial lead perforation may lead to pneumopericardium or pneumothorax within a few days of device implantation.

METHODS AND RESULTS

We report a case of atrial lead perforation 6 years after cardiac resynchronization therapy implantation, which resulted in pneumopericardium and pneumothorax.

CONCLUSION

Although pneumopericardium caused by atrial lead perforation can spontaneously resolve with conservative treatment, as it did in this case, treatment should be decided based on the patient's general condition and lead performance.

A Case of Contralateral Pneumothorax, Pneumomediastinum, and Pneumopericardium after Dual-Chamber Pacemaker Implantation

As permanent pacemaker implantation is increasingly becoming a common practice, it is important to understand potential complications associated with the procedure. We present a 78-year-old Caucasian female who developed contralateral pneumomediastinum, pneumothorax, and pneumopericardium after undergoing implantation of a dual-chamber pacemaker.

Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum

Cardiac implantable electronic devices (CIED) including pacemakers (PM), implantable cardioverter defibrillators (ICD), and cardiac resynchronized therapy (CRT) have become the mainstay of therapy for many cardiac conditions, consequently drawing attention to the risks and benefits of these procedures. Although CIED implantation is usually a safe procedure, pneumothorax remains an important complication and may contribute to increased morbidity, mortality, length of stay, and hospital costs. On the other hand, pneumopericardium and pneumomediastinum are rare but potentially fatal complications. Accordingly, a high degree of awareness about these complications is important. Pneumothorax almost always occurs on the ipsilateral side of implantation. The development of contralateral pneumothorax is uncommon and may be undetected on an initial chest radiograph. Contralateral pneumothorax with concurrent pneumopericardium and pneumomediastinum is much rarer. We describe a rare case of concurrent right-sided pneumothorax with pneumopericardium and pneumomediastinum after left-sided pacemaker implantation and highlight the risk factors, management, and possible ways to prevent the complications.

Pneumothorax leading to pneumopericardium after transvenous lead implantation in a patient with previous epicardial lead

A 44-year-old lady, a follow-up case of idiopathic dilated cardiomyopathy and cardiac resynchronization therapy defibrillator device implantation with epicardial left ventricular (LV) lead, underwent a transvenous LV lead revision in view of epicardial lead malfunction. A chest X-ray after this, done for worsening dyspnea, revealed pneumopericardium along with left pneumothorax. The computed tomography (CT) revealed a communication between the left pleural and pericardial cavities, around the old epicardial lead. Drainage of the left pleural cavity resolved both the pneumothorax and pneumopericardium and the patient remained well on follow up.

Bilateral Pneumothorax Complicating Pacemaker Implantation, due to Puncture of the Left Subclavian Vein and Electrode Perforation of the Right Atrium

Pneumothorax occurs mostly due to needle injury of the pleura when trying to get access to the subclavian vein and rarely due to electrode perforation. The present case report is the first case presented about acute simultaneous iatrogenic bilateral pneumothorax due to puncture of the left subclavian vein and electrode perforation of the atrial wall, the pericardium, and the pleura. Risk factors, and how to avoid these complications, are highlighted, and symptoms, diagnostics, and management of pneumothorax and cardiac perforation are described.

Postural Conversion Computed Tomography for the Diagnosis of Pneumopericardium due to Perforation by the Active Atrial Lead

A 71-year-old woman with cardiac sarcoidosis underwent an implantable cardioverter-defibrillator implantation in the left precordium to prevent fatal arrhythmias. Two weeks later, she presented with dyspnea. Chest X-ray revealed right pneumothorax due to the active atrial lead perforation. Subsequently, air was detected surrounding the heart. Although it was difficult to differentiate pneumopericardium from pneumomediastinum, postural conversion computed tomography (CT) in the supine and prone positions documented air migration in the pericardial cavity and diagnosed pneumopericardium. This rare case of pneumopericardium combined with pneumothorax contralateral to the venous access site highlights the utility of postural conversion CT for diagnosis of pneumopericardium.

An unexpected complication of intracardiac device implantation: Contralateral pneumothorax and pneumopericardium

A 62-year-old man developed concomitant right-sided pneumothorax and pneumopericardium after undergoing implantation of a left-sided dual-chamber pacemaker. The case is reported for its rarity. The possible mechanisms and management options for this extremely rare complication are discussed.