Related Experiment Video
Updated: May 21, 2026
07:12
An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
Published on: September 8, 2023
Pulsatile abdominal mass is not always leaking aneurysm!
Syed Viqar Ahmed1, Philip Anthony McMillan, Chaminda Jayawarna
1Department of Acute Medicine, Stepping Hill Hospital, Stockport, Cheshire, UK. syedviqarahmed@hotmail.com
BMJ Case Reports
|June 6, 2012
Summary
A pacemaker lead displacement caused diaphragmatic stimulation, leading to collapse in an elderly male. Repositioning the lead resolved the issue, highlighting the importance of proper device placement.
Area of Science:
- Cardiology
- Medical Devices
- Neurology
Background:
- An 80-year-old male experienced unexplained collapses.
- He had a new ventricular demand inhibited pacemaker implanted for bradycardia with atrial fibrillation.
Observation:
- A pulsating mass was noted in the upper abdomen, disappearing with the 'head and shoulder' technique.
- Electrocardiogram (ECG) revealed a heart rate of 32 bpm with atrial fibrillation and no pacing spikes.
- Chest X-ray showed pacemaker lead displacement into the right subclavian vein.
Findings:
- The misplaced pacemaker lead stimulated the phrenic nerve.
- This stimulation caused rhythmic diaphragmatic contractions, mimicking an abdominal pulsation and leading to collapse.
Implications:
- Pacemaker lead malposition can cause unusual symptoms like diaphragmatic stimulation and syncope.
- Proper pacemaker placement and lead integrity are crucial for patient safety.
- This case underscores the need for thorough investigation of syncope in patients with new cardiac devices.
Related Concept Videos
01:30Aneurysm I: Introduction
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
01:25Assessment of the Abdomen I: Inspection and Auscultation
Introduction
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection.
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection.
01:19Appendicitis
Appendicitis is an acute inflammatory condition of the vermiform appendix, most commonly caused by obstruction of its lumen. The appendix is a narrow, blind-ended pouch that extends from the cecum, making it particularly prone to obstruction. Causes include fecaliths, lymphoid hyperplasia (often after viral infections), parasites, tumors, or foreign bodies. This obstruction initiates a cascade of pathological changes.Luminal Obstruction and Early InflammationAfter obstruction, normal mucosal...
01:23Assessment of the Abdomen III: Palpation
Palpation is a crucial tactile examination method for assessing abdominal organs and detecting conditions like tenderness, distention, masses, or fluid. It involves both light and deep palpation techniques, each serving specific diagnostic purposes. Light palpation helps identify tenderness and other surface-level indicators, while deep palpation locates and assess abdominal masses and organ boundaries. A skilled professional can gather valuable insights through palpation, including evaluating...