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Large Unilateral Pleural Effusion with Pacemaker-associated Post-cardiac Injury Syndrome
Sundeep Kumar1, Abed Madanieh1, Hiren Patel1
1Internal Medicine, University of Central Florida College of Medicine, Orlando, USA.
Cureus
|November 7, 2018
Summary
Post-cardiac injury syndrome (PCIS) is a rare complication of permanent pacemaker implantation. This case highlights PCIS presenting as pleural effusion, mimicking other conditions, and emphasizes diagnostic challenges.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Complications
Background:
- Post-cardiac injury syndrome (PCIS) is an uncommon delayed complication following cardiac procedures.
- Permanent pacemaker implantation is a common procedure, but associated complications like PCIS are rarely documented.
Observation:
- A 67-year-old male presented with dyspnea and chest discomfort post-dual chamber permanent pacemaker implantation.
- Initial diagnosis of pericarditis was made, treated with ibuprofen, but symptoms worsened.
- A large right-sided pleural effusion was identified, requiring chest tube drainage; fluid analysis was exudative and non-infectious.
Findings:
- Despite clinical suspicion for cardiac chamber perforation due to lead proximity, imaging (echocardiogram, CT) and pacemaker interrogation were inconclusive.
- Repeat CT scan showed resolution of pleural effusion after chest tube placement.
- Absence of typical pericardial findings might be attributed to prior non-steroidal anti-inflammatory drug (NSAID) therapy.
Implications:
- This case underscores the infrequent presentation of PCIS as significant pleural effusion after pacemaker implantation.
- Diagnostic challenges in PCIS necessitate a high index of suspicion and comprehensive evaluation.
- Understanding atypical presentations and the role of prior treatments is crucial for managing PCIS.
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