An 87-year-old man presented at the hospital with shortness of breath and syncope. His medical history included ischemic heart disease, emphysema, and hypertension. An electrocardiogram showed complete heart block and nonsustained polymorphic ventricular tachycardia. A temporary ventricular pacing wire was inserted. In the coronary care unit, the patient was treated for a community-acquired chest infection. A dual-chamber permanent pacemaker (PPM) was inserted by means of left cephalic vein cutdown. Active-fixation leads were used. After implantation, a device check, lead check, and chest radiograph revealed nothing abnormal. Eight days later, the patient had dyspnea and hemoptysis. A chest radiograph showed patchy consolidation in the lower zone of both lung fields, the right atrial pacing lead's tip situated outside the cardiac silhouette, and evidence of pneumopericardium (Fig. 1). At the regional cardiology center, the right atrial pacing lead was uneventfully removed and replaced with a passive-fixation lead. The patient was discharged from the center 3 days later. Fig. 1 Chest radiograph shows an extracardiac location of the right atrial pacing lead tip (arrow) and pneumopericardium. The arrowhead indicates the pericardial outline.