Pacemaker Lead Perforation Presenting as Persistent Abdominal Pain: A Case Report
Drew W Barron1, Nathan G Rasmussen1, Mark H Auerbach2
1Emergency Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, USA.
Cureus
|June 16, 2025
Summary
Pacemaker lead perforation is a rare complication presenting with atypical pain. CT imaging is crucial for diagnosing lead migration and myocardial perforation, especially in challenging cases.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cardiac pacemakers are essential devices for managing arrhythmias.
- Lead perforation is a rare but serious complication of pacemaker implantation.
- Atypical presentations can significantly challenge diagnosis.
Observation:
- A 79-year-old male with comorbidities and a new dual-chamber pacemaker developed unexplained left upper quadrant abdominal pain.
- Multiple emergency department visits and prior diagnostic workups, including ECG, CXR, and CT, failed to identify the cause.
- Subsequent CT imaging revealed migration of the right atrial pacemaker lead, suggesting myocardial perforation.
Findings:
- Myocardial perforation from pacemaker leads can manifest acutely, subacutely, or chronically.
- Subacute and chronic perforations often present with non-specific symptoms, complicating diagnosis.
- Advanced imaging, particularly CT, is vital for detecting lead migration and perforation.
Implications:
- This case underscores the importance of considering pacemaker lead migration in patients with unexplained pain post-implantation.
- It highlights the limitations of conventional diagnostic tools and the value of CT in identifying this complication.
- Management varies from conservative observation to lead extraction, depending on patient stability and risk.
Related Concept Videos
01:22Esophageal Perforation-I: Introduction
851
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
851
01:28Esophageal Perforation-II: Clinical Manifestations and Management
1.1K
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
1.1K
01:24Chronic Pancreatitis I: Introduction
918
The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
918
01:22Appendicitis-I: Introduction
4.5K
The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
4.5K
01:19Pericarditis II: Clinical Features and Diagnostic Tests
638
Pericarditis is distinguished by inflammation of the pericardium, the fibrous sac that encases the heart. It can be acute, lasting less than six weeks, or chronic, persisting for over three months. Understanding its clinical manifestations and diagnostic findings is crucial for timely and effective management.Clinical ManifestationsWhile pericarditis can be asymptomatic, it usually presents with characteristic symptoms such as:Chest Pain: The most characteristic symptom of pericarditis is chest...
638
01:19Appendicitis
33
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...
33