Subacute pacemaker lead migration with cardiac perforation and extracardiac extension into lung parenchyma with associated pneumothorax

Cardiac perforation with extracardiac extension by a pacemaker lead is a rare but serious complication of pacemaker placement. We present a unique case with imaging of a patient who underwent pacemaker placement complicated by subacute migration of the pacemaker lead, resulting in perforation involving interventricular septum, right ventricular apex, pericardium, epicardial fat, pleura and left upper lobe parenchyma with left-sided pneumothorax.