Massive Tension Hemothorax After Pacemaker Implantation

Matthia, Eldon; Matar, Ralph; Altshuler, Ellery; Kerensky, Richard A.; Arnaoutakis, George J.; Shah, Sunny; Omar, A. R.; Agarwal, Zubin; Miles, William S.; Xiang, Kun

doi:10.7759/cureus.16754

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…Patients may present with chest pain, dyspnoea, tachycardia, and even hypotension if there is associated haemorrhagic shock. 2 Ipsilateral haemothorax can be a consequence of ventricular perforation, inadvertent vascular injury whilst obtaining access or direct lung injury. 1 , 3 The presence of haemothorax without pneumothorax should alert the clinician to potential cardiac perforation as a cause rather than vascular injury sustained whilst attempting venous access.…”

Section: Discussionmentioning

confidence: 99%

An unusual cause of a haemothorax following pacemaker implantation: A case report

Saunderson

Hogarth

Papaspyros

et al. 2022

European Heart Journal - Case Reports

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Background Haemothoraces are a reported but extremely rare complication of pacemaker implantation. Haemothoraces can be a consequence of lead perforation through the right ventricle (RV) and pericardium into the pleural space, direct lung or vascular injury during access. Case Summary A 72-year-old woman presented 24 hours after a pacemaker implantation with chest pain and shortness of breath. Computed tomography of the chest confirmed perforation of the RV lead into the left pleural cavity with a large left sided haemothorax. Following percutaneous drainage of the left sided haemothorax the patient became haemodynamically unstable necessitating emergent sternotomy. During surgery the extra-cardiac portion of the pacing lead was cut, the RV repaired and a large haematoma evacuated from the left pleural space. Despite this the patient remained hypotensive and further exploration showed a bleeding intercostal artery that had been lacerated by the pacing lead. This was treated by electrocautery and the patient’s haemodynamic status improved. The RV lead remnant was removed transvenously via the subclavian vein and the patient was left with a single chamber atrial pacemaker. Discussion Prompt recognition of RV lead perforation and its associated sequalae, often utilising multi-modality imaging, is vital to enable transfer to a centre with cardiac surgical expertise. In this case the perforating RV lead lacerated an intercostal artery and this was only identified at the time of surgery. In order to minimise the risk of perforation multiple fluoroscopic views should be used and care should be taken during helix deployment.

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Section: Discussionmentioning

confidence: 99%

An unusual cause of a haemothorax following pacemaker implantation: A case report

Saunderson

Hogarth

Papaspyros

et al. 2022

European Heart Journal - Case Reports

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“…According to Advanced Trauma Life Support guidelines, tension pneumothorax is a clinical diagnosis reflecting air under pressure in the affected pleural space and is characterized by some or all of the following signs and symptoms: chest pain, air, hunger, tachypnea, respiratory distress, tachycardia, hypotension, tracheal deviation away from the side of the injury, unilateral absence of breath sounds, elevated hemothorax without respiratory movement, neck vein distention, and cyanosis. Although there is no definition of tension hemothorax, findings such as chest pain, tachypnea, hypotension, and neck vein distention may indicate tamponade or tension physiology [2,3]. Although the mediastinal shift appears moderate in Figure 3B, it is possible that tension hemothorax was further advanced during preparation for thoracic drainage.…”

Section: Discussionmentioning

confidence: 99%

Delayed Tension Hemothorax With Nondisplaced Rib Fractures After Blunt Thoracic Trauma

Hamamoto¹,

Kikuta²,

Takahashi³

et al. 2023

Cureus

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Blunt thoracic trauma often causes rib fractures, hemothorax, and pneumothorax. Although there is no established definition regarding the duration and management of delayed hemothorax, it commonly occurs in a few days and exhibits at least one displaced rib fracture. Moreover, delayed hemothorax rarely develops tension hemothorax. A 58-year-old male who had a motorcycle accident received conservative treatment from his orthopedic doctor. He felt a sudden severe chest pain 19 days after the accident. Contrast-enhanced computed tomography (CT) of the chest revealed multiple left-sided rib fractures without displacement, left pleural effusion, and extravasation near the intercostal space of the seventh rib fracture. After transfer to our hospital and a plain CT scan, which showed a more mediastinal shift toward the right, his condition deteriorated with cardiorespiratory embarrassment, such as restlessness, hypotension, and neck vein distention. We diagnosed him with obstructive shock due to tension hemothorax. Immediate chest drainage ameliorated restlessness and elevated blood pressure. Here, we report an extremely rare and atypical case of delayed tension hemothorax after blunt thoracic trauma without displaced rib fractures.

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Massive Tension Hemothorax After Pacemaker Implantation

Cited by 2 publications

References 9 publications

An unusual cause of a haemothorax following pacemaker implantation: A case report

An unusual cause of a haemothorax following pacemaker implantation: A case report

Delayed Tension Hemothorax With Nondisplaced Rib Fractures After Blunt Thoracic Trauma

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