Swan Ganz catheter misplacement with pulmonary artery rupture
Diagnosis certain
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Updates to Freetext Attributes
Description
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Patient presents 250 ml of hemoptysis 20 minutes after the Rx is made, and an urgent CT angiography is requested.
Updates to Case Attributes
Presentation
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Patient with history of congestive heart failure, hypertension and cardiovascular bypass presents to the hospital with acute dyspnea.
Further evaluation reveals a requirement for a Swan Ganz catheter and a diagnosis of pulmonary hypertension is made.
Patient presents 250 ml of hemoptysis 20 minutes after the Rx
A routine chest X-ray is maderequested.
Body
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On the contrast enhanced CT (angiography), the distal end of the catheter was found in the middle lobe, medial segment, perforating the lobar artery with active contrast extravasation (hemorrhage).
Patient died of refractary hypotension during surgery, due to the hemorrhage.
The catheter missplacement was not initially reported as an acute urgent finding until the hemoptysis presented. A note to remember when examining a chest x-ray with a Swan Ganz out of place.
-<p>On the contrast enhanced CT (angiography), the distal end of the catheter was found in the middle lobe, medial segment, perforating the lobar artery with active contrast extravasation (hemorrhage).</p><p>Patient died of refractary hypotension during surgery, due to the hemorrhage.</p><p> </p>- +<p>On the contrast enhanced CT (angiography), the distal end of the catheter was found in the middle lobe, medial segment, perforating the lobar artery with active contrast extravasation (hemorrhage).</p><p>Patient died of refractary hypotension during surgery, due to the hemorrhage.</p><p>The catheter missplacement was not initially reported as an acute urgent finding until the hemoptysis presented. A note to remember when examining a chest x-ray with a Swan Ganz out of place.</p><p> </p>
Systems changed:
- Vascular
- Interventional
Tags changed:
- swan ganz
- catheter
- pulmonary artery
Updates to Quizquestion Attributes
Question
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What is the most likely diagnosis?
Answer
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Swan Ganz catheter missplacement, with associated pulmonary interstitial edema, possibly explained by the congestive heart failure.
Updates to Quizquestion Attributes
Question
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What has just happened to this patient?
Answer
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The blood coughing likely originates from a rupture in the pulmonary artery when the Swan Ganz was reinflated. We should have first suspected this on the plain chest X-ray.
The alveolar pattern first seen on the X-ray is now most likely an alveolar hemorrhage.
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