Conclusion
This case highlights a rare but potentially devastating complication of intrapericardial LVAD placement. Fortunately, the patient recovered well and faces no major long-term consequences. However, symptoms of ongoing chest wall trauma went unrecognized for three days, despite radiography demonstrating the pump housing abutting the chest wall. In patients with significant cardiomegally or left ventricular dilation, alternative siting strategies should be considered, and a high index of suspicion should be maintained for chest wall injury if the apical position is used.