Pacemaker-generated stress fracture of the second rib: a case report
Jus Ksela1, Mark Racman2, Rok Zbacnik3
1Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia. jus.ksela@kclj.si.
Journal of Cardiothoracic Surgery
|September 17, 2020
Summary
A rare case of pacemaker-induced rib fracture in an asthenic young woman highlights unique complications. Sub-muscular pacemaker placement in patients with specific body types may lead to stress fractures, requiring advanced imaging and intervention.
Area of Science:
- Cardiology
- Medical Device Technology
- Orthopedics
Background:
- Cardiovascular implantable electronic devices (CIEDs) can cause pocket-related complications, including infection, erosion, and migration.
- Bone lesions and nerve impairment are rare CIED complications.
- This case involves a 20-year-old asthenic female with recurrent pocket infections post-pacemaker implantation.
Observation:
- The patient presented with spontaneous, severe pocket pain without trauma or exertion, 9 months after sub-pectoral pacemaker implantation.
- Thoracic CT and PET-CT scans ruled out infection but revealed a healing stress fracture of the second rib.
- The fracture was attributed to repetitive pressure from the sub-muscularly placed pulse generator during normal movement.
Findings:
- Sub-muscular pacemaker implantation in asthenic patients with small thoraxes can lead to unique adverse events.
- Repetitive mechanical stress from the device can cause fatigue stress fractures in underlying bone.
- This case demonstrates a device-generated stress fracture of the second rib.
Implications:
- Advanced diagnostic imaging is crucial for identifying rare pacemaker-related bone complications.
- Sub-muscular pacemaker placement in susceptible individuals may require careful consideration of device size and pocket location.
- Timely intervention, including device repositioning or replacement, can alleviate pain and improve quality of life.
Keywords:
Cardiovascular implantable electronic deviceCase reportPocket-related complicationStress fractureMore Related Videos
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