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Case Reports
. 2019 Oct;1(3):381-384.
doi: 10.1016/j.jaccas.2019.07.038.

Pneumopericardium and Pneumomediastinum After Implantation of a Cardiac Resynchronization Pacemaker

Peregrine G Green  1 , Neil Herring  1
Affiliations
Case Reports

Pneumopericardium and Pneumomediastinum After Implantation of a Cardiac Resynchronization Pacemaker

Peregrine G Green et al. JACC Case Rep. 2019 Oct.

Abstract

A patient with previous coronary artery bypass grafting developed an iatrogenic pneumothorax, along with pneumopericardium and pneumomediastinum, after elective implantation of a cardiac resynchronization therapy pacemaker. There was no evidence of lead perforation, and the patient remained well and was successfully managed conservatively. We hypothesize that air tracked from the pneumothorax via microscopic pleuropericardial fistulae. (Level of Difficulty: Intermediate.).

Keywords: CRT, cardiac resynchronization therapy; CRT-P, cardiac resynchronization therapy pacemaker; CT, computed tomography; CXR, chest radiograph; complication; fistula; pacemaker; pneumomediastinum; pneumopericardium.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Radiological Demonstration of Pneumothorax, Pneuomomediastinum, and Pneumopericardium (A) Posterior-anterior (PA) chest radiograph demonstrating pneumothorax (asterisk) and pneumopericardium/pneumomediastinum (arrows). (B) Resolution on follow-up radiograph. (C and D) Axial computed tomography chest slices demonstrating pneumothorax and pneumopericardium/pneumomediastinum.
Figure 2
Figure 2
Diagrammatic Representation of the Mechanisms of Pneumomediastinum Formation
See this image and copyright information in PMC

Comment in

  • When Uncontrolled, Air Can Give You a Hard Time.
    Schmiady MO, Van Hemelrijck M, Mestres CA. Schmiady MO, et al. JACC Case Rep. 2019 Oct 16;1(3):385-386. doi: 10.1016/j.jaccas.2019.09.001. eCollection 2019 Oct. JACC Case Rep. 2019. PMID: 34316830 Free PMC article.

References

    1. Byrd C.L. Safe introducer technique for pacemaker lead implantation. Pacing Clin Electrophysiol. 1992;15:262–267. - PubMed
    1. Ogunbayo G.O., Charnigo R., Darrat Y. Incidence, predictors, and outcomes associated with pneumothorax during cardiac electronic device implantation: a 16-year review in over 3.7 million patients. Heart Rhythm. 2017;14:1764–1770. - PubMed
    1. Liccardo M., Nocerino P., Gaia S., Ciardiello C. Efficacy of ultrasound-guided axillary/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study. J Interv Card Electrophysiol. 2018;51:153–160. - PubMed
    1. Girerd N., Lienhart A.S., Chevalier P. Pneumomediastinum after implantable cardiac defibrillator implantation. Eur Heart J. 2011;32:429. - PubMed
    1. Espiritu J.D., Keller C.A. Pneumomediastinum and subcutaneous emphysema from pacemaker placement. Pacing Clin Electrophysiol. 2003;24:1041–1042. - PubMed

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