Pneumothorax is a well-recognized complication of central venous line insertion (CVL). Rarely, pneumothorax can lead to electrocardiogram (ECG) findings mimicking ST-segment elevation myocardial infarction. We present a 63-year-old man with iatrogenic right-sided pneumothorax who developed ST-segment elevation on a 12-lead ECG suggestive of myocardial infarction. The ECG findings completely resolved after needle decompression and chest tube placement. This case points up this rare electrocardiographic finding with discussion of possible mechanisms and differential diagnosis.
ST-segment elevation when seen on telemetry and confirmed on a 12-lead electrocardiogram (ECG) should alarm the physicians about the possibility of acute myocardial infarction, which warrants rapid intervention. Rarely, other etiologies may lead to rapid onset ST-segment elevation [
A 63-year-old male with history of severe COPD, hypertension, and coronary artery disease presented with worsening dyspnea of one-week duration and vomiting and fever for two days. In the emergency department, his vital signs were stable except for temperature of 100.6 f (38.1 c). Oxygen saturation was 96% on 4L Nasal Cannula (NC). Physical examination revealed crackles heard over left lower hemithorax. Laboratory studies showed an arterial blood gas (ABG) of 7.39/49/48/29 on 4 NC, white blood cells count of 12.3 K/
(a) Electrocardiogram showing ST-segment elevation in anterior leads with reciprocal changes in inferior leads (b) electrocardiogram after needle decompression and chest tube placement showing complete resolution of ST-segment elevation in anterior leads.
(a) Chest X-Ray showing large right-sided pneumothorax with lung margin collapse more than 4 cm from the chest wall uniformly. (b) Chest X-Ray showing Interval placement of chest tube with tip in the right suprahilar area with near-complete lung reexpansion.
Central venous line (CVL) insertion is a common procedure in the intensive care unit setting. Pneumothorax is a well-recognized complication of CVL insertion [
ECG changes are seen in approximately 25% of the Pneumothorax cases [
ST-segment elevation has been reported in diverse pathologies including hyperkalemia, early repolarization, left bundle branch block, acute pericarditis, intracerebral bleeding, and Brugada syndrome [
Practitioners should be aware about pneumothorax as an immediate complication of central venous line insertion and that it could present as ST-segment elevation so that a delay in diagnosis and treatment can be prevented. The whole clinical picture including patient’s history and review of laboratory and radiological investigations is essential. ST-segment elevation should be scrutinized in relation to the clinical presentation and not as a diagnostic indicator of myocardial infarction on its own.
The authors declare no conflicts of interest.