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Severe Venous and Lymphatic Obstruction after Single‐Chamber Pacemaker Implantation in a Patient with Chest Radiation Therapy
Author(s) -
DIAMOND JOSHUA M.,
KOTLOFF ROBERT M.,
LIU CHRISTOPHER F.,
COOPER JOSHUA M.
Publication year - 2010
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02652.x
Subject(s) - medicine , chylothorax , superior vena cava syndrome , superior vena cava , surgery , subclavian vein , radiology , thoracentesis , pleural effusion , sick sinus syndrome , cardiology , catheter
A 73 ‐ year ‐ old woman with a history of paroxysmal atrial fibrillation, sinus node dysfunction, bilateral breast cancer, and extensive chest radiation developed progressive edema, dyspnea, and recurrent pleural effusions soon after single ‐ chamber pacemaker implantation. Thoracentesis yielded a diagnosis of chylothorax, and progressive refractory anasarca developed. A computed tomography angiogram suggested obstruction of the superior vena cava and left subclavian vein despite outpatient therapeutic anticoagulation. Autopsy confirmed venous thrombosis, along with mediastinal fibrosis. The presumed etiology of the chylothorax and anasarca was obstruction of the atretic central venous structures following pacemaker implantation, critically impairing the already tenuous venous and lymphatic drainage. (PACE 2010; 520–524)