Imaging Case of the Week 137

The following chest x-rays are from two different patients in their 80s. One patient has had a single chamber pacemaker inserted for a complete heart block and the other an ICD for VT/ischaemic cardiomyopathy. Which is which?


Chest x-ray APchest x-ray AP view

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The 1st chest x-ray is from the patient who had an implantable cardioverter defibrillator inserted for episodes of VT with an ischaemic cardiomyopathy.

The 2nd chest x-ray is from the patient with a single chamber permanent pacemaker.

How do you differentiate?

ICD has shock coils (focal thickening) in the right ventricle and the SVC whereas pacemakers do not have shock coils.