CTICasesDefibrillator Lead Fracture and Shock Coil Fragmentation
Imaging findings
Chest radiographs show fragmentation and unwinding of the shock coil lead of a Medtronic defibrillator at the level of the first rib and clavicle (Nutcracker site). Post-removal radiographs show multiple metallic fragments left behind in the chest wall.
Key takeaways
Defibrillator leads are susceptible to mechanical fatigue and fracture. The junction between the first rib and clavicle is a classic site of lead compression (Nutcracker effect). Lead failure can lead to coil fragmentation and migration of fragments into the surrounding chest wall.
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