CTICasesPacemaker Lead Perforation with Hemopericardium
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Imaging findings
A non-contrast, prospectively gated cardiac CT demonstrates a moderate-sized pericardial effusion of high attenuation (consistent with blood). The tip of the right ventricular pacemaker lead is clearly visualized perforating through the right ventricular myocardium, extending into the epicardial fat and abutting the pericardium.
Key takeaways
Pacemaker lead perforation is a mechanical complication that typically occurs within the first few weeks after implantation. Prospectively gated cardiac CT is highly valuable for evaluating suspected lead dislodgement or perforation, as it minimizes cardiac motion artifacts and clearly delineates the lead tip's position relative to the thin right ventricular wall.
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