Catheter-induced pulmonary artery haemorrhage resulting from a pneumothorax.
We present a case of pulmonary artery perforation in a patient who developed a pneumothorax after cardiac surgery. In the process of inserting a chest tube the patient became tachypnoeic, and developed haemoptysis. The trachea was intubated, and right bronchial intubation was performed with persistent bleeding. The pulmonary artery catheter was gently withdrawn and the balloon inflated, with cessation of bleeding. The patient was taken to the operating room, a bronchial blocker was placed in the right lower lobe bronchi, and the pulmonary artery catheter was removed. The bronchial blocker was removed the following day with no bleeding. The aetiology of perforation was secondary to the pneumothorax, which caused a shift of the mediastinum to the right, elevated pulmonary artery pressures, and the distal migration of the catheter through the pulmonary artery. It is recommended that treatment include tracheal intubation, inflation of the pulmonary artery catheter balloon, and the placement of a right lower lobe bronchial blocker.
Mangar
D
D
Department of Anesthesiology, University of South Florida College of Medicine, Tampa 33612.
Connell
G R
GR
Lessin
J L
JL
Räsänen
J
J
D000368:Aged; D001980:Bronchi; D002404:Catheterization / Q000295:instrumentation; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006469:Hemoptysis / Q000209:etiology* / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal; D011030:Pneumothorax / Q000150:complications*; D011651:Pulmonary Artery / Q000293:injuries* / Q000473:pathology; D012421:Rupture