CTICasesPacemaker Lead Fracture (Subclavian Crush)
Imaging findings
A pacemaker atrial lead shows a gap indicating a fracture, with deformation of the lead beneath the clavicle at the costoclavicular space. A prior study five years earlier and an interval pulse generator change are noted, and the clinical history confirmed the study was done for known lead dysfunction and fracture.
Key takeaways
Pacemaker leads can fracture from subclavian crush in the confined costoclavicular space, where the clavicle and first rib compress the lead during normal arm motion, and a device entering the vein medially (or an interval generator change stressing the lead) may predispose to this. A practical rule is to zoom in over the costoclavicular space on any chest exam with a lead, since occasionally the reader will be first to detect a subtle fracture the clinicians are unaware of, though most fractures are already known because the device malfunctions.
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