Pneumopericardium caused by a permanent endocardial pacing lead.

A 59-year-old woman with a history of bronchiectasis was admitted due to a two-day history of fever and hemosputum. A permanent pacemaker (DDD mode, screw-in lead) had been implanted three months previously to treat complete atrioventricular block. On computed tomography, pneumopericardium was seen, and the right atrium pacing lead was stuck into the right lung. A semi-emergency operation to remove the pacing lead and part of the right middle lobe was performed through a right thoracotomy. Although pneumopericardium caused by pacing lead perforation is rare, the possibility of perforation by the pacing lead should always be considered.