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Swan Ganz Catheter Induced Pulmonary Artery Pseudoaneurysm



General Considerations

  • Rupture of pulmonary artery with Swan Ganz catheter placement reported between 0.05 and 0.4% of cases
  • Overall, major complications with Swan Ganz catheters seen in up to 17% of cases
  • Pseudoaneurysms have a female predominance
  • Causes may include
    • Inflation in a peripheral pulmonary artery
    • Hyperinflation of balloon
    • Vigorous flushing
  • Risk factors include
    • Age over 60
    • Anti-coagulant therapy
    • Pulmonary arterial hypertension
    • Chronic steroid use

Clinical Findings

  • Hemoptysis

Imaging Findings

  • Chest radiography
    • Lower and middle lobe pulmonary artery branches most affected
    • Consolidation corresponding to parenchymal hemorrhage
    • Nodule corresponding to pseudoaneurysm may appear 1-3 weeks later
  • CT
    • With contrast, an enhancing mass adjacent to a vessel
    • Dense nodule with halo of fainter density
  • Angiography
    • "Gold standard"
      • Extravascular collection arising from a vessel

Differential Diagnosis

  • Acute invasive aspergillosis

Treatment

  • Trans-catheter embolization is treatment of choice
  • Emergency surgical ligation
  • Lobectomy

Complications

  • Enlargement and re-hemorrhage

Prognosis

  • Mortality can be as high as 50% from pulmonary hemorrhage

Swan Ganz Catheter-induced Pulmonary Artery pseudoaneurysm. Red arrow points to collection of contrast which yellow arrow shows to be in the same location as the tip of the Swan ganz catheter (blue arrow) inserted 3 days earlier too peripherally in a branch of the right descending pulmonary artery.
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Catheter-Induced Pulmonary Artery Pseudoaneurysm: Immediate Transcatheter Embolization of Swan-Ganz. Prasanta Karak, Richard Dimick, Kay M. Hamrick, Marc Schwartzberg and Souheil Saddekni.  Chest 1997;111; 1450-1452

 

Guttentag, AR, Shepard, JO, McLoud, TC Catheter-induced pulmonary artery pseudoaneurysm: the halo sign on CT. AJR Am J Roentgenol 1992;158,637-63