False pulmonary artery catheter measurements due to the scimitar (hypogenetic lung) syndrome. Potential for iatrogenic pulmonary edema.
In an acute trauma patient with unrecognized scimitar syndrome, physiologic measurements used in patient management decisions were misleading due to the anatomic and physiologic anomalies of the syndrome. Pulmonary artery catheter measurements believed to reflect left atrial pressures were actually measuring central venous pressures because the catheter was terminating in the scimitar vein. These erroneous measurements led to overly aggressive fluid resuscitation and iatrogenic pulmonary edema. The pathologic features of scimitar syndrome are reviewed, and the mechanism for potential mismanagement of patient volume status created by aberrant pulmonary hemodynamics is discussed.
Pomerantz
S M
SM
Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore.
Mirvis
S E
SE
Siegel
E L
EL
Belzberg
H
H
D002404:Catheterization; D002496:Central Venous Pressure; D003951:Diagnostic Errors; D005440:Fluid Therapy / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy; D011651:Pulmonary Artery; D011654:Pulmonary Edema / Q000209:etiology*; D011669:Pulmonary Wedge Pressure; D012587:Scimitar Syndrome / Q000150:complications / Q000503:physiopathology*