Chylous Collection in the Pacemaker Pocket Masquerading as Infection

Although a largely safe procedure, a variety of complications may arise from pacemaker implantation. One rare complication involves chylous collections forming at the pacemaker pocket.

A 58-year-old woman with myotonic dystrophy and a dual-chamber pacemaker presented with chronic swelling over her pacemaker site. Imaging revealed a large fluid collection. Needle aspiration yielded 600 mL of milky, odorless fluid with a triglyceride level of 403 mg/dL, consistent with a chylous effusion. Lymphangiography and lymphoscintigraphy suggested impaired thoracic duct drainage, likely secondary to iatrogenic injury during pacemaker implantation. The patient was managed with a low-fat diet and remained asymptomatic without recurrence.

Chylous fluid collections in pacemaker pockets are a rarely documented postsurgical complication. Understanding of diagnosis and treatment of this complication remains poorly explored.

This case emphasizes the need to consider lymphatic disruption in patients with persistent device site fluid collections.