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Sudden onset of hypoxia and respiratory distress post permanent pacemaker insertion.
Chest radiograph - mobile
Large bilateral pneumothoraces. Sternotomy wires and dual lead pacemaker in situ.
The patient developed sudden respiratory distress and hypoxia within an hour of a permanent pacemaker insertion. A pneumothorax was suspected but chest radiographs were obtained prior to decompression. The patient was managed initially with bilateral needle thoracostomy and subsequent bilateral intercostal catheterization.
Ipsilateral pneumothorax is a well recognized but rare complication of a permanent pacemaker insertion. However bilateral pneumothoraces are exceptionally rare. This case also demonstrates the difficulty in clinically diagnosing possible bilateral tension pneumothoraces as many associated clinical signs (hyperresonant percussion, reduced air entry etc) will be bilateral and therefore difficult to identify. The rapid clinical improvement of symptoms post decompression in this case supported the diagnosis of bilateral tension pneumothoraces.