Swan Ganz catheter misplacement with pulmonary artery rupture

• distal

  Distal end of the Swan Ganz catheter in the middle lobe

• diffuse.

  Diffuse

  alveolar pattern in the right basal and middle lobes. Blunting of the left costophrenic angle, pacemaker, and sternal strapping

.

Lung window

• distal end of the Swan Ganz catheter in the middle lobe, medial segment, with intraparenchematous 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

Patient presents 250 mlmL of hemoptysis 20 minutes after the Rxdiagnosis is made, and an urgent CT angiography is requested.

The blood coughing likely originates from a rupture in the pulmonary artery when the Swan Ganz was reinflated. The alveolar pattern first seen on the Xx-ray is now most likely an alveolar hemorrhage.