Abstract

Cardiac implantable electronic device implantation is a widely performed procedure and is generally considered to be low risk. Nevertheless, rare but potentially life-threatening complications may occur. Pneumothorax is the most frequently reported pulmonary complication related to venous puncture during the procedure; however, pulmonary parenchymal injury and alveolar hemorrhage in the absence of pneumothorax are exceedingly rare. In this case report, we present a 72-year-old male patient in whom regional pulmonary parenchymal injury and alveolar hemorrhage developed following subclavian vein puncture during implantable cardioverter-defibrillator implantation performed for primary prevention, without radiological evidence of pneumothorax. After the onset of hemoptysis during the procedure, imaging studies revealed no pneumothorax, while thoracic computed tomography demonstrated findings consistent with parenchymal and alveolar hemorrhage in the upper lobe of the lung. The patient was successfully managed with close clinical monitoring and conservative treatment, resulting in complete clinical recovery. This case highlights that, in patients presenting with pulmonary symptoms during or after cardiac device implantation, rare complications other than pneumothorax should also be considered. Early diagnosis using appropriate imaging modalities and a conservative management strategy may be effective in selected cases.