Ann Thorac Surg 2001;72:1400
© 2001 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Traumatic rib fracture caused by a pulse generator
Ádám Böhm, MDa,
László Hajdú, MDa,
István Préda, MDa
a Second Department of Medicine, and Department of Cardiovascular Surgery, Faculty of Health Sciences, Semmelweiss University, Budapest, Hungary
Address reprint requests to Dr Böhm, 2nd Department of Medicine, Faculty of Health Sciences, Semmelweiss University, Szabolcs Str. 33-35, Budapest, 1135 Hungary
e-mail: bohm{at}freemail.hu
A 57-year-old woman presenting with sick sinus syndrome underwent pacemaker implantation and received a Biotronik Pikos VVI pulse generator (Biotronik Co, Berlin, Germany). She was enrolled in a regular follow-up program and was free of symptoms for 6 years. Then she had a car accident. While she was sitting in her parked car, behind the steering wheel—she did not use the safety belt—a truck hit her car from behind. She had blunt chest trauma, and blacked out for a few minutes.
During her traumatology evaluation, the physical examination revealed serious multiple suffusions on her anterior chest wall. There was not any neurological deficit. The brain computed tomographic scan and pos-teroanterior chest x-ray film did not show any pathological finding.
Since the sharp pain around her pacemaker box did not subside despite her improving general condition, a repeat chest roentgenogram was carried out 4 days later, from a special right anterior oblique projection this time, which showed signs of traumatic fracture on the fourth rib (Fig 1, arrow).
The hard titanium housing of the pacemaker box hit the patient’s chest wall and resulted in a rib fracture which was visible only on a special right anterior oblique chest roentgenogram projection, but not on a regular posteroanterior chest roentgenogram. The mechanical insult of the pacemaker box did not lead to any pacemaker dysfunction, but the pulse generator dislocated laterally and became uncomfortable for the patient, therefore it had to be replaced 4 months later.
