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Case of the Week 422




What is the most likely diagnosis?

  • 64 year-old male with new onset of bradycardia



Chest radiographs (reversed) done 6 months apart

  1. Pericardial tamponade
  2. Fractured lead
  3. Lead migration
  4. Battery failure
  5. Twiddler's syndrome

Additional Images - CT scan of chest

 

 

Additional Images

 

CT scan of lower chest (window optimized for finding)


Answer:

.


3. Lead migration (perforation)

.

.

More (Click Discussion Tab)


Pacemaker Lead Perforation

General Considerations

  • Perforation can occur during placement (more frequent) or delayed (up to 5 years after implantation)
  • Cardiac tissue has a "self-sealing" capacity
  • Incidence of around 1% for pacemakers and 1-5% for cardiac defibrillators
  • Probably more common than originally thought

MORE...


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LearningRadiology.com
is an award-winning educational website aimed primarily at medical students and radiology residents-in-training, containing  lectures, handouts, images, Cases of the Week, archives of cases, quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, GU cardiac, bone and neuroradiology.