Three-dimensional echocardiographic documentation of pacemaker lead perforation presenting as acute pericarditis.

Myocardial perforation is a rare complication of permanent pacemaker insertion and is usually detected during the first month after implantation. Pericardial effusion often occurs at the same time, and as a consequence may generate difficulties in the diagnostic workup due to the various aetiologies of its origin. Computed tomography has been used for the documentation of lead perforation, but its diagnostic accuracy in comparison to echocardiographic examination has not been validated. We report a case of ventricular perforation causing pericarditis, initially undetected by computed tomography, that was finally diagnosed by means of real-time three-dimensional echocardiography.