Presentation
Recurrent pericardial effusion, drained and reaccumulated. PPM inserted 3 months prior. NOAC related? Lead issue?
Patient Data
Dual-lead left pectoral cardiac pacing device in situ. Leads positioned in the right atrium and right ventricle. The right atrial lead tip extends anteriorly tenting the atrial wall and possibly through it. The leads and tips are intact.
Moderate to large volume pericardial effusion overlying the right atrium with density of 15 HU. Four-chamber cardiomegaly, particularly the right heart chambers. Ectatic ascending aorta. Stable dilation of the main pulmonary trunk. No pulmonary embolus on non-dedicated imaging.
Interval decrease in size of the small bilateral pleural effusions. Associated atelectasis of the lower lobes.
No axillary, mediastinal or hilar lymphadenopathy.
Multilevel thoracic vertebral body hemangiomas. Slight wedging of the T12 vertebral body, with superior endplate Schmorl's node. No acute bony abnormality.
Imaged upper abdominal viscera are unremarkable on this non-dedicated study.
IMPRESSION
The right atrial pacing lead is positioned anteriorly in the right atrium, either tenting the anterior wall or perforating it. Pacing leads and tips are intact. Moderate to large volume pericardial effusion.
Interval decrease in size of the bilateral pleural effusions and associated collapse of the lower lobes.
Case Discussion
The atrial wire was removed and another wire inserted. The pericardial effusion resolved.