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Pacemaker-associated cyanosis in an adolescent: The answer hiding behind shadows
Sg Wittekind1, Jc Salerno, Ae Rubio
1Pediatric Residency Program, University of Washington, Seattle, WA.
Images in Paediatric Cardiology
|May 31, 2013
Summary
Intracardiac pacemaker lead thrombi can cause significant complications, even in adolescents. This case highlights the diagnostic challenges and obstructive effects of lead thrombosis on cardiac function.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Permanent transvenous pacemaker (PM) implantation is a common procedure.
- Lead thrombosis is a known, though infrequent, complication of PMs.
- Diagnosis can be challenging, particularly in pediatric patients.
Observation:
- An adolescent patient with a dual-chamber PM presented with fatigue and hypoxemia.
- Diagnostic imaging modalities had limitations in clearly visualizing the thrombi.
- The patient exhibited signs of tricuspid valve inflow obstruction.
Findings:
- The patient was diagnosed with intracardiac PM lead thrombi.
- The thrombi were obstructing the tricuspid valve inflow.
- A review of pediatric literature on PM lead thrombosis was conducted.
Implications:
- This case underscores the importance of considering lead thrombosis in pediatric patients with PMs presenting with unexplained symptoms.
- Diagnostic challenges associated with imaging lead thrombosis require careful consideration.
- Prompt diagnosis and management are crucial to prevent severe hemodynamic compromise.
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