Myung s Shin, M.D., F.C.C.P.;(*1) R...

Myung s Shin, M.D., F.C.C.P.;(*1) Russel C Reeve M.D.;([unkeyable]) and Kang-Jey Ho MD Ph.D.([unkeyable])

A classic case of Swan-Ganz catheter-induced pulmonary infection was studied with one as well as the other conventional chest radiography and comput tomography (CT) Chest radiography initially showed a fan-shaped opacity in the right middle lobe which later became somewhat orbiculared with no discernible cavitation. However, a cavitary lung lesion with a bulls-eye appearance was clearly demonstrated by means of CT. We speculate that of the like kind a cavitary lung lesion might be quite public in catheter-induced pulmonary infarction when CT is widely applied to of that kind cases.

The use of the flow-directed balloon-tipped (Swan-Ganz) catheter for measurement of pulmonary artery and capillary wedge urgency is generally considered safe.[1,2] However, complications associated with its use do occur[3-9] The in the greatest degree common one is pulmonary infarction which is usually noncavitary and explains within two to three weeks.[3-5] We have previously reported the radiographic findings of rare cavitary lung lesions as the inference of use of the Swan-Ganz catheter in pair patients.[9] No computed tomography (CT) was performed at that time. lately we have encountered another case of catheter-induced pulmonary infarction in which a cavitary lung lesion was not discovered by conventional radiography, but was clearly demonstrated by the agency of CT. Such cavitary lung lesions may in fact not be in like manner rare when CT is applied to them instead of plain chest radiography.

CASE REPORT

A 69-year-old woman was admitted with the chief complaint of returning chest pain. Her past medical history included bilateral oophorectomy for ovarian cancer, hemicolectomy for colonic diverticulitis, bilateral mastectomies for breast cancer, and coronary artery bypass grafting, respectively 1969 1985 1986 and common year ago. She also had adult-onset diabetes mellitus, hypertension, and hypercholesterolemia.

upon admission, acute anterior myocardial infarction was documented by means of electrocardiography and serum enzyme studies. Because of impending heart failure with pulmonary edema, a Swan-Ganz catheter was inserted into the right pulmonary artery for hemodynamic monitoring. Initially, the pulmonary artery and capillary wedge compressings were reported to be 50/25 and 25 mm Hg respectively.

forward the second hospital day, the patient had an episode of mild hemoptysis. The tip of the catheter was checked via radiography and was base to wedge persistently in a peripheral artery. The catheter was backed abroad with return of its urgency tracing to normal. The patient, however, lay opened a fan-shaped opacity in the right middle lobe (Fig 1) The opacity was apparently an acute infarction secondary to the arterial occlusion at the permanently wedged catheter tip. Despite the accident, the patient's cardiac condition was stabilized on conservative medical treatment alone. Ten days later the right lower lobe opacity resolv to a 2-3 cm orbiculared opacity with ill-defined border and absence of central cavitation (Fig 2) CT was carried disclosed which revealed a round mass of inhomogeneous density with a radiolucent ring surrounding a radiopaque center resembling a bulls-eye (Fig 3) Obviously, the infarcted lung make knowned a central cavity containing either vital current clot or necrotic tissue. She was given prophylactic antibiotics. pair months later, follow-up chest radiography revealed that the right middle lobe opacity resolv completely

DISCUSSION

Pulmonary complications of the flow-directed balloon-tipped (Swan-Ganz) catheter are rather infrequent.[1,2] Among those rare complications, pulmonary infarction is through far most common.[3-5] This is caused by means of the persistent wedging of the catheter tip in a peripheral artery because the catheter has a predisposition to slip distally into like a wedge position.[10] The infarction usually interprets within two to three weeks.[4] Central cavitation of the infarcted lung is considered to be quite rare. We have previously documented pair such rare cases.[9] The infarcted lung in these couple patients were secondarily infected and movement forwarded to cavitary lung abscesses.

forward conventional chest radiography the catheter tip persistently wedged in a peripheral artery can easily be visualized. A fan-shaped opacity spreading from the catheter tip toward the periphery of the lung portray by actions the infarcted lung. The opacity then becomes smaller and somewhat sphericaled and eventually disappears or forms a scar. As a control no cavity can be clearly observ upon plain chest radiography. The not away case is such a typical example. Although no cavitary lesion was discernible according to plain chest films in this patient (Fig 1 2) a cavity with bulls-eye appearance was clearly demonstrated on CT (Fig 3). The patient was treated prophylactically with antibiotics and showed no sign or symptom of bacterial pneumonia. The cavity was, therefore, in the greatest degree likely either a hematoma or liquefying infarcted lung tissue, instead of an abscess. of that kind a cavitary lung lesion might show one stage of the natural course of catheter-induced pulmonary infarction in the series from infarction, liquefaction, cavitation, and collapse to fibrosis.