BUDD-CHIARI SYNDROME DUE TO PACEMAKER-INDUCED THROMBOSIS

We report a unique case of Budd-Chiari syndrome caused by pacemaker le ads-induced thrombosis. A 34 year old female patient was subjected to a permanent pacemaker insertion because of refractory paroxysmal supra ventricular tachycardia attacks related to Wolff-Parkinson-White syndr ome. Three years later, another pacemaker was re-implanted because of its dislodgement. Four episodes of skin infections at the implantation site were noted thereafter. The patient developed symptoms of abdomin al pain and ascites 5 years after the second pacemaker implantation. U ltrasonography and computerized tomography of the abdomen revealed hep atomegaly with ascites and dilated inferior vena cava. An echocardiogr am displayed thrombus formation in the superior vena cava, the right a trium and the inlet of the inferior vena cava into the right atrium. I nferior and superior venacavogram confirmed the above findings. With t he impression that Budd-Chiari syndrome was caused by pacemaker-induce d thrombus, we removed the pacemaker first and thoracotomy with thromb ectomy was then performed. The clinical symptoms resolved after the op eration. To our knowledge, this is the first case reported in the lite rature and this observation supported the thrombosis theory for membra nous obstruction of inferior vena cava.