Kerala Heart Journal -Anurag

Case report

Kerala Heart J  2016; 6(2):xx-xx. 
 

Right ventricular apical mass after pacemaker implantation


Anurag Bahekar*, Sajan Ahmad Z*, George Koshy*, K. Venugopal*, Jacob Therakathu**



*Dept.of Cardiology    ** Dept.of Radiology, Pushpagiri Medical College, Tiruvalla, Kerala

Corresponding author

Dr Anurag Bahekar

Senior Resident

Department of Cardiology

Puspagiri Institute of medical sciences,  Thiruvalla, Kerala


Case history:

46-year-old gentleman, a case of symptomatic high degree AV block on temporary pacemaker via right femoral venous access (for 4 days) underwent a permanent pacemaker (VDDR) implantation via left subclavian venous access.

 

Echocardiography:

Echocardiography post procedure showed a mobile structure attached to the RV apical endocardium, near the insertion of the pacemaker lead.

 

Differential diagnosis:

1.      Thrombus at site of RV lead

2.      RV trabecular tear

3.      Endocardial vegetation

 

Discussion:

         Patient had no history of fever.

ESR value - 20mm/hr. (unlikely to be vegetation)

         Echo density of the mobile structure appeared similar to that of RV trabeculae

 

Management:

         Planned for Cardiac MRI/CT for tissue characterization

CT was done (as pacemaker was not MRI compatible).  Due to extensive pacemaker lead artifacts, CT images were non-contributory.      

         Oral anticoagulation was started in view of possibility of RV apical thrombus

         Follow up echo.

 

Conclusion:

            2D echo at 3 weeks interval showed significant regression of the mobile structure, suggesting that thrombus could be the most possible etiology


Figure 1


   
Figure 2

      







Refbacks

  • There are currently no refbacks.