Friday, August 08, 2008


When a patient complains of "left shoulder pain which began 30 minutes ago, is pulsitile and sharp, comes and goes, and is associated with a left abdominal pulsation which began yesterday:"

Click image to enlarge

... always check the implanted biventricular defibrillator lead locations.



Joseph B said...

how did the lead get that far back?

DrWes said...

joseph b-

I have no earthly idea. At the time of revision, the lead had migrated all the wayback to the sewing sleeve. Inspection demonstrated the sewing sleeve was secured with two, tightly-sutured 2-0 Ethibond sutures, and the remainder of the lead had coiled into the device pocket. Neither the RA or RV lead appeared to be torqued, ruling out the potential for "Twiddler's Syndrome."

Joseph B said...

I've read about a situation where leads can get pulled back by some 'ratcheting' mechanism where the lead can move back through the anchoring sleeve but not forward. I don't know if that is a real phenomenon...

nice cxr.