All Journals from Azhar Farooqui
An 82-year-old lady was found on the floor of her home, confused and surrounded by vomitus. She had a past medical history of type II diabetes, hypothyroidism, previous left total hip replacement, and previous hip fracture treated with right dynamic screw fixation. Prior to the current presentation she had been living alone, mobilizing independently with a walking stick and self-caring for her activities of daily living. She was last seen by her daughter on the previous day, and reported no concerning symptoms.
This is a T2 weighted image (T2WI). In T2WI compartments filled with fluid appear brighter (as is the case of the CSF in the lateral ventricles). On the contrary, tissues with a high fat content appear as dark. This T2WI demonstrates layering of debris (figure 2- marked red star) in the occipital horn of the lateral ventricles. In this particular patient, the complete MRI report additionally demonstrated that the debris did not show a high T1 signal, demonstrated diffusion restriction, and a high FLAIR sequence. There was also restricting material observed in the fourth ventricle and the sylvian fissures bilaterally. There were no parenchymal changes or pathological contrast enhancements within the brain tissue. Whilst this appearance could represent blood, the appearance of the debrinous material itself was more in keeping with infective/pus material within the ventricles suggestive of ventriculitis.
Myocardial perforation is a rare yet serious complication following cardiac pacemaker or defibrillator device procedures.
In this article, the authors describe a case of right ventricular pacemaker lead perforation presenting to our hospital’s medical assessment unit with a clinical presentation suggestive of an acute pulmonary embolism. Treatment dose low molecular weight heparin (LMWH) was commenced while awaiting CT scan. CT images were negative for PE however demonstrated RV lead perforation. Echocardiogram demonstrated pericardial effusion with the tip of RV lead in the pericardial free space. A rapid deterioration in the patient’s haemodynamics prompted an emergency pericardial drain insertion and successful RV lead re-position in the cardiac catheter lab. The patient recovered well and was discharged with routine pacemaker clinic follow-up.
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