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Cardiovascular Disease |

Hemoptysis: A Red Flag for Pseudoaneurysm After Pulmonary Artery Catheterization FREE TO VIEW

Min Qi, DO; Keriann Van Nostrand, MD; William Carlos, MD; Farzad Loghmani, MD
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Indiana University, Indianapolis, IN


Chest. 2014;146(4_MeetingAbstracts):99A. doi:10.1378/chest.1992472
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Abstract

SESSION TITLE: Cardiovascular Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Pulmonary artery catheters (PAC) are routinely used in the diagnosis and management of pulmonary hypertension with minimal risks. Pulmonary artery pseudoaneurysm or rupture is a rare and potentially fatal complication of PA catheterization. We present a case of pulmonary artery catheter-induced pseudoaneurysm promptly diagnosed and treated by coil embolization.

CASE PRESENTATION: A 69 year old woman with history of diabetes and hypertension was evaluated for three months history of lower extremity edema, abdominal distension and orthopnea. Transthoracic echocardiogram at that time was notable for diastolic dysfunction and right ventricular systolic pressure of ~55mmHg. Right and left heart catheterizations were performed to further investigate her heart failure. Left heart catheterization was notable for single vessel disease in Obtuse Marginal 2 and left ventricular end diastolic pressure of 27mmHg. Right heart catheterization was then performed under fluoroscopic guidance and showed pulmonary artery pressure of 56/33 mmHg and wedge pressure of 21mmHg. Unexpectedly, during removal of the pulmonary arterial catheter, the patient developed massive hemoptysis (~300ml). Cessation of the hemoptysis allowed for chest computed tomography (CT) to be performed as the patient remained hemodynamically stable. Chest CT revealed a right middle lobe pulmonary artery pseudoaneursym. Pulmonary angiography confirmed these findings as the source of hemoptysis. Two coils were successfully deployed: one in the pseudoaneurysm and the second coil in the feeding branch. She subsequently required a transfusion for a four gram decrease in her hemoglobin level. She did not have any further hemoptysis during her hospitalization and was discharged home.

DISCUSSION: Pulmonary artery pseudoaneurysm or rupture, while rare, is the most serious and life-threatening complication from PAC insertions. Hemoptysis is the initial presenting symptom suggestive of PA injury in more than 80% of cases. Left untreated, risk of re-bleeding from the pseudoaneurysm is 30-40% with mortality rate of 40-70%. Our case illustrates the importance of prompt diagnosis and management of right middle lobe pseudoaneursym from pulmonary artery catheterization

CONCLUSIONS: Hemoptysis in patients who have undergone PAC should raise suspicion for pseudoaneurysm formation and receive prompt evaluation with CT scan or pulmonary angiogram. Timely recognition and treatment with surgery or coil embolization are necessary to prevent morbidity and mortality.

Reference #1: Pulmonary artery pseudoaneurysm after Swan-Ganz catherization: a case presentation and review of literature. Nellaiyappan M, et al. European Heart Journal: Acute Cardiovascular Care 2014; Published online January 27, 2014.

Reference #2: Catheter-induced pulmonary artery pseudoaneurysm formation: Three case reports and a review of the literature. Poplausky M, et al. Chest 2001; 120:2105-2111.

DISCLOSURE: The following authors have nothing to disclose: Min Qi, Keriann Van Nostrand, William Carlos, Farzad Loghmani

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