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Iatrogenic pneumothorax

Case contributed by Dr Michael Lousick

Presentation

Routine chest XR post pacemaker insertion.

Patient Data

Age: 80 years
Gender: Male
X-ray

Routine post pernament pacemaker insertion

Interval placement of left chest dual-lead pacemaker, no lead complications
evident. A moderate left pneumothorax is present, measuring 5 cm to the apex, also
visible around the left base with maximal projected depth of approximately
2.5 cm. Multiple healed fractures evident.

X-ray

Repeat CXR 24 hours later.

There has been an interval increase in the left-sided pneumothorax compared to previous imaging 1 day prior. There is partial atelectasis of the left mid and lower zones.

X-ray

Drain insertion

Interval placement of a left intercostal catheter, tip projected over the mid to lower zone. Significant size reduction of the left-sided pneumothorax.

X-ray

Stable position of the left-sided intercostal pigtail catheter. The pneumothorax has decreased in volume in the lower zone, but remained stable in the apex. There is an increased amount of gas within the thoracic wall soft tissues around the drain, extending both superiorly and inferiorly.

Case Discussion

Pneumothorax is a rare but well recognized complication of permanent pacemaker (PPM) insertion with documented complication rates between < 1 to 2.5% 1,2. However most of these tend to be small and are managed conservatively. The presented patient developed a new oxygen requirement and a repeat chest radiograph 24 hours later showed increasing size of the pneumothorax. He was successfully managed with and intercostal catheter which was removed 72 hours later without complication.

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Case information

rID: 77015
Published: 3rd May 2020
Last edited: 4th May 2020
System: Chest
Inclusion in quiz mode: Included
Institution: Gold Coast University Hospital

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