Acute Left Hemothorax as a Late Complication of an Active-Fixation Pacemaker Lead Giovanni B. Forleo, MD, PhD, Jacob Zeitani, MD, PhD, Tommaso Perretta,

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Presentation transcript:

Acute Left Hemothorax as a Late Complication of an Active-Fixation Pacemaker Lead Giovanni B. Forleo, MD, PhD, Jacob Zeitani, MD, PhD, Tommaso Perretta, MD, PhD, Domenico G. Della Rocca, MD, Luca Santini, MD, PhD, Giovanni Simonetti, MD, Francesco Romeo, MD The Annals of Thoracic Surgery Volume 95, Issue 3, Pages 1081-1084 (March 2013) DOI: 10.1016/j.athoracsur.2012.07.064 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Chest radiograph (posterior-anterior view) on the day of presentation with complete heart block 7 months after pacemaker implantation and (B) before the patient was taken to the surgery room approximately 310 days after primary device placement. In A, the ventricular lead tip is apparently located in right ventricle (RV) apex, whereas in B the retained RV lead (arrow) has changed orientation. The Annals of Thoracic Surgery 2013 95, 1081-1084DOI: (10.1016/j.athoracsur.2012.07.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A, B) Computed tomographic (CT) scans 7 months after primary pacemaker implantation show that the tip of the lead (arrow) apparently crossed through the RV apex without evidence of pericardial effusion. (C, D) Three months later, CT axial images obtained at the same level show that the tip of the retained lead has perforated the RV apex (empty arrow) with left pleural massive hemorrhage (asterisks) from an actively bleeding intercostal artery (white arrow). The Annals of Thoracic Surgery 2013 95, 1081-1084DOI: (10.1016/j.athoracsur.2012.07.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Axial, (B) sagittal, and (C) coronal computed tomographic reconstructions showing left pleural massive hemorrhage (asterisks). (D) The maximum-intensity projection reconstruction shows the perforated ventricular lead tip terminating in the left antero-lateral chest wall (arrow) with a massive hemorrhage (asterisk) from an actively bleeding intercostal artery close to the tip of the retained lead. The Annals of Thoracic Surgery 2013 95, 1081-1084DOI: (10.1016/j.athoracsur.2012.07.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions