[az_accordion_section] [accordion title=”History” id=”acc-1″]A 70 year old man presents to the Emergency Department following a witnessed syncope whilst seated. He describes a 2 day history of intermittent palpitations with associated light-headedness but no chest pain or shortness of breath. This is his first episode of syncope. His examination findings were benign. You proceed to order a chest radiograph.[/accordion]

[accordion title=”CXR” id=”acc-2″]What are the two most significant findings on this radiograph?[/accordion]

[accordion title=”Answer” id=”acc-3″]

There is an AICD in-situ. The right atrial and right ventricular leads are in satisfactory position, however the coronary sinus lead has migrated back into the superior vena cava.

There is also coarse curvilinear calcification projected over the left ventricle consistent with a calcified left ventricular aneurysm, a consequence of a previous myocardial infarction.

Compare this examination to the radiograph performed post-AICD insertion in which the lead positions are appropriate.[/accordion]