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Unusual cause of a pulsatile abdominal mass
1Department of Emergency Medicine, Southampton General Hospital, Southamptom, UK . hakrawi@yahoo.com
Emergency Medicine Journal : EMJ
|July 27, 2007
Summary
A maladjusted cardiac resynchronisation therapy (CRT) pacemaker caused abdominal pulsation by stimulating the diaphragm. This condition mimicked an abdominal aortic aneurysm due to synchronized contractions.
Area of Science:
- Cardiology
- Medical Devices
- Biomedical Engineering
Background:
- Cardiac resynchronisation therapy (CRT) devices, including implantable defibrillators, are used to manage heart failure.
- Pacemaker malfunction can lead to unintended physiological effects.
Observation:
- A patient presented with abdominal pulsation, a symptom typically associated with serious vascular conditions.
- The pulsation was synchronous with the patient's heart beat.
Findings:
- The abdominal pulsation was directly linked to a maladjusted CRT device.
- The CRT device erroneously stimulated the diaphragm, causing repetitive contractions.
- This diaphragmatic stimulation mimicked the clinical presentation of an abdominal aortic aneurysm.
Implications:
- Highlights the importance of proper device calibration and monitoring for CRT systems.
- Underscores the need for clinicians to consider device malfunction in the differential diagnosis of abdominal pulsation.
- Suggests potential for diaphragm stimulation as a complication of cardiac implantable electronic devices.
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