Iatrogenic pneumothorax

Case contributed by Dr Michael Lousick

Presentation

Routine chest XR post pacemaker insertion.

Patient Data

Age: 80 years
Gender: Male

Routine post pernament pacemaker insertion

X-ray

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.

Repeat CXR 24 hours later.

X-ray

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.

Drain insertion

X-ray

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.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.