title: Recognition and management of catheter-induced pulmonary artery rupture.
abstract: BACKGROUND
  Catheter-induced pulmonary artery rupture is a well-recognized complication of invasive monitoring, but the risk has not diminished. Although commonly associated with cardiopulmonary bypass, injuries also occur in intensive care. Definitive proof requires pulmonary angiography or autopsy. Many cases are never reported, and lesser injuries are probably under-diagnosed.
  
  
  METHODS
  Seven cases fulfilling accepted diagnostic criteria discovered over 2 years are described in four groups illustrating the common modes of presentation: hemoptysis with hypoxemia, exsanguination, delayed recurrent hemorrhage, and bleeding with cardiopulmonary bypass.
  
  
  RESULTS
  One patient had a planned elective operation deferred. Four patients were being monitored in intensive care. Two of them died of pulmonary artery rupture. Two other patients had bleeding on weaning from cardiopulmonary bypass. One settled with conservative treatment, the other survived after extracorporeal life support. Recognition and management are discussed, emphasizing means of avoiding pulmonary resection.
  
  
  CONCLUSIONS
  Catheter-induced pulmonary artery rupture is unavoidable. Constant awareness is essential. A plan of management is presented. Extracorporeal life support may help to avoid pulmonary resection. Early pulmonary angiography is advocated for accurate diagnosis and to enable treatment by embolization.
authors.affiliation: Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Australia.
authors.forename: M H
authors.initials: MH
authors.lastname: Mullerworth
authors.forename: P
authors.initials: P
authors.lastname: Angelopoulos
authors.forename: M A
authors.initials: MA
authors.lastname: Couyant
authors.forename: A M
authors.initials: AM
authors.lastname: Horton
authors.forename: S M
authors.initials: SM
authors.lastname: Robinson
authors.forename: O U
authors.initials: OU
authors.lastname: Petring
authors.forename: P J
authors.initials: PJ
authors.lastname: Mitchell
authors.forename: J J
authors.initials: JJ
authors.lastname: Presneill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002315:Cardiopulmonary Bypass; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects*; D003422:Critical Care; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008991:Monitoring, Physiologic / Q000009:adverse effects; D011651:Pulmonary Artery / Q000293:injuries*; D012421:Rupture