Pulsatile abdominal mass is not always leaking aneurysm!. (21st February 2012)

• Record Type: Journal Article
• Authors: Ahmed, Syed Viqar; McMillan, Philip Anthony; Jayawarna, Chaminda
• Is Part Of: BMJ case reports. Volume 2012
• Publication Date: 2012-02-21
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr.07.2011.4497
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : An 80-year-old male, who presented with a history of unprovoked collapse, was found to have a visible pulsation in the central upper abdomen, which disappeared on raising his arms above his shoulder ('head and shoulder' technique). There was no tenderness noted over the pulsation. He had a ventricular demand inhibited pacemaker inserted 3 weeks ago for a significant bradycardia with atrial fibrillation. His ECG showed heart rate of 32 bpm with underlying atrial fibrillation. No pacing spikes noted. His chest x-ray confirmed displacement of pacing lead into the right subclavian vein. It caused stimulation of phrenic nerve resulting in rhythmical diaphragmatic contraction. He later had his pacemaker re-inserted with no more collapses.