Commentary to : Higny J, Benoît M, Clarembeau F, Henry J-P. An Electronic Device Floating in Hemothorax: When POCUS Helps to FOCUS. Clinical Case Reports. 2025;13:e71293.I read with great interest the report by Higny et al., presenting a remarkable case of rightventricular lead perforation resulting in massive hemothorax, in which Point-of-CareUltrasound (POCUS) enabled rapid diagnosis and timely intervention. The authors are to becommended for illustrating the critical clinical value of bedside ultrasound in anuncommon yet potentially fatal complication of cardiac device implantation.This case emphasizes several important considerations for physicians managing patientswith cardiac implantable electronic devices (CIEDs). First, it highlights the diagnosticstrength of POCUS in the evaluation of sudden cardiorespiratory deterioration during thepost-implant period. In contrast to conventional radiography, POCUS permits immediatedetection of simultaneous cardiac and pleural pathology, enabling real-time clinicaldecision-making when every minute is decisive.Second, this report reinforces the need to further integrate structured POCUS training intocardiology, intensive care, and emergency medicine curricula. While professional societiesadvocate competency in focused ultrasound, implementation remains heterogeneous.Systematic early post-implant POCUS, particularly among high-risk groups—older adults,recipients of active-fixation leads, and patients receiving anticoagulation—could allowdetection of subclinical lead migration prior to overt perforation or hemodynamiccompromise.Third, although computed tomography remains the reference standard for anatomicaldetail, this case elegantly demonstrates that POCUS is not only a diagnostic instrument butalso a procedural adjunct, supporting pleural decompression, characterizing effusions, andraising immediate suspicion of lead misplacement at the bedside. Future prospectivestudies comparing the diagnostic performance of POCUS against conventional imaging forlead-associated complications would be of significant clinical value.In summary, this important case further substantiates that POCUS has evolved beyond anadjunct modality to become a core component of acute cardiovascular and thoracicassessment. The work by Higny et al. strengthens the growing evidence base supportingroutine, early ultrasound evaluation in suspected CIED complications and contributesmeaningfully to improving patient safety in device medicine.I thank the authors for their insightful contribution and for highlighting the pivotal role ofPOCUS in time-critical cardiovascular care.Conflict of Interest: The author declares no conflict of interest.Funding: None.Sincerely,Sara Gonzalez Lastra, MDDepartment of Intensive Care MedicineRoyal Brompton and Harefield HospitalsLondon, United KingdomEmail: s.lastra@nhs.netReferences1. Higny J, Benoît M, Clarembeau F, Henry J-P. An Electronic Device Floating inHemothorax: When POCUS Helps to FOCUS. Clin Case Rep. 2025;13:e71293.2. Labovitz AJ, et al. Focused cardiac ultrasound in the emergent setting: A consensusstatement. J Am Soc Echocardiogr. 2010;23(12):1225–1230.3. Rajkumar CA, et al. Diagnosis and management of iatrogenic cardiac perforation causedby pacemaker and defibrillator leads. EP Europace. 2017;19(6):1031–1037.4. Vamos M, et al. Incidence of cardiac perforation with conventional and leadlesspacemaker systems: A systematic review and meta-analysis. J Cardiovasc Electrophysiol.2017;28(3):336–346.5. Soni NJ, et al. Ultrasound in the diagnosis and management of pleural effusions. J HospMed. 2015;10(12):811–816.