# Intramural Hematoma and Acute Pulmonary Embolism Following Pacemaker Implantation: A Case Report

## TL;DR

A patient developed a rare combination of aortic intramural hematoma and pulmonary embolism after pacemaker implantation, managed conservatively with successful recovery.

## Contribution

Presents a rare case linking subclavian vein access complications to intramural hematoma and pulmonary embolism.

## Key findings

- Intramural hematoma likely resulted from subclavian artery trauma during pacemaker implantation.
- Acute pulmonary embolism may have arisen from a prothrombotic state following the procedure.
- Conservative management with CT monitoring successfully resolved both conditions.

## Abstract

Bleeding complications after pacemaker implantation pose risks, including infection and prolonged hospital stay. A case involving aortic intramural hematoma (IMH) arising from subclavian vein access during implantation and concomitant acute pulmonary embolism (PE) is presented. In the present case, IMH probably resulted from subclavian artery vasa vasorum trauma during vein puncture and guidewire advancement, leading to IMH and hemothorax. PE possibly stemmed from a prothrombotic state caused by the intervention and the IMH. Conservative management with serial CT scans was chosen due to hemodynamic stability and high surgical risk. IMH and PE resolution was confirmed at follow-up.