Presentation
Chest pain after pacemaker placement
Patient Data
Two lead pacemaker, one lead in the right atrial appendage, the second lead tip has perforated the right ventricular wall and is in the pericardial space. Small high density pericardial effusion represents hemopericardium. Compare with small bland pleural effusions.
Case Discussion
Blood products are dense, so it's no surprise that a hemopericardium will be denser than a bland effusion. There are many potential etiologies for a hemopericardium, but most are due to bleeding into the pericardial space (e.g. myocarial perforation due to trauma, ruptured ventricular aneurysm, ruptured aortic dissection, ruptured coronary artery etc.). In this case, the right ventricular lead perforated the right ventricle, resulting in a hemopericardium.
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