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We present two cases of pacemaker-associated haemopericardium with markedly different physiological consequences: one showed haemodynamic instability with clear tamponade and the other initially stable without tamponade despite a massive effusion. This case pair demonstrates how POCUS can be used to differentiate these states and underscores the importance of evaluating both the heart and the patient as a whole.<\/jats:p>","DOI":"10.1136\/bcr-2025-271517","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:25:22Z","timestamp":1787232322000},"page":"e271517","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Contrasting ultrasound findings in pacemaker lead perforation with and without cardiac tamponade"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-1477","authenticated-orcid":false,"given":"James","family":"Chan","sequence":"first","affiliation":[{"name":"Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"},{"name":"Emergency Medicine, Mercy Health St Rita\u2019s Medical Center, Lima, Ohio, 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