Introduction
Pneumothorax after pacemaker implantation is a well-known complication, reported in less than 1% of cases.1 The pneumothorax occurs as a complication of transvenous access. Pneumopericardium along with pneumothorax has been rarely reported to occur after pacemaker implantation. With a left sided implantation, the mechanism of pneumopericardium is different when it is associated with a right pneumothorax vis a vis a left pneumothorax. In this report, we present an interesting case with a novel mechanism of pneumopericardium associated with left pneumothorax.