CTICasesAtrial pacemaker lead perforation with hemopericardium
Imaging findings
Chest radiograph and non-contrast CT demonstrate that the right atrial pacing lead has perforated through the atrial wall into the pericardial space, presenting with a high-lying tip and hemopericardium with tamponade.
Key takeaways
Pacemaker lead perforation is a rare complication that most commonly involves the RV, but can occur in the atrium. An unusually high position or abnormal sweep of the atrial lead on radiograph is a key clue, and CT is definitive in showing the lead tip in the pericardial space.
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