Swan Ganz catheter misplacement with pulmonary artery rupture
Diagnosis certain
Updates to Case Attributes
Status
changed from pending review to published (public).
Published At
was set to
.
Presentation
was changed:
Patient with a history of congestive heart failure, hypertension, and cardiovascular bypass. Consults to the emergency department presenting acute dyspnea.
Further evaluation reveals a requirement for a Swan Ganz catheter and a diagnosis of pulmonary hypertension is made.
A routine chest X-ray is requested.
Body
was changed:
On the contrast-enhanced CT, the distal end of the catheter can be visualized in the middle lobe, medial segment, perforating the lobar artery. There is active contrast extravasation, compatible with hemorrhage. The patient died of refractory hypotension during surgery, due to massive bleeding.
The catheter misplacement was not initially reported as an acute urgent finding until the hemoptysis presented. A note to remember when examining post Swan-Ganz colocation x-rays.
-<p>On the contrast-enhanced CT, the distal end of the catheter can be visualized in the middle lobe, medial segment, perforating the lobar artery. There is active contrast extravasation, compatible with hemorrhage. The patient died of refractory hypotension during surgery, due to massive bleeding.</p><p>The catheter misplacement was not initially reported as an acute urgent finding until the hemoptysis presented. A note to remember when examining post Swan-Ganz colocation x-rays.</p><p> </p>- +<p>On the contrast-enhanced CT, the distal end of the catheter can be visualized in the middle lobe, medial segment, perforating the lobar artery. There is active contrast extravasation, compatible with hemorrhage. The patient died of refractory hypotension during surgery, due to massive bleeding.</p><p>The catheter misplacement was not initially reported as an acute urgent finding until the hemoptysis presented. A note to remember when examining post Swan-Ganz colocation x-rays.</p>
References changed:
- 1. Barash P, Barash ND, Barash HG et-al. Catheter-induced pulmonary artery perforation. Mechanisms, management, and modifications. (1981) The Journal of thoracic and cardiovascular surgery. <a href="https://doi.org/">doi:</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/7242132">Pubmed</a> <span class="ref_v4"></span>
- 1. Barash P, Barash ND, Barash HG, Barash WSG, Barash CD, Barash LH, Barash KC, Barash BA, Barash GA, Barash. Catheter-induced pulmonary artery perforation. Mechanisms, management, and modifications. (1981) The Journal of thoracic and cardiovascular surgery. <a href="https://doi.org/">doi:</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/7242132">Pubmed</a> <span class="ref_v4"></span>
Updates to Study Attributes
Findings
was changed:
- distal end of the Swan Ganz catheter in the middle lobe, medial segment, with
intraparenquimatousintraparenchematous trajectory, perforating the middle lobe artery (best seen on the non-contrast CT) - diffuse alveolar pattern in the right basal and middle lobes with acute contrast extravasation visible on the contrast-enhanced CT, compatible with active hemorrhage 1,2
- bilateral pleural effusion
- peacemaker and sternal post-surgery changes
- 3D heart reconstruction shows the distal end of the catheter in white, perforating the middle lobe artery