Embolization of a pulmonary arterial pseudoaneurysm with endovascular coils

Pulmonary artery pseudoaneurysm after Swan-Ganz catheterization: a case presentation and review of literature

INTRODUCTION

The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature.

METHODS

We reviewed all PubMed/Medline indexed articles published between 1993-2013, reporting the development of PA pseudoaneurysm after Swan-Ganz catheter use. Cases were analyzed with specific reference to patient demographics, indication for Swan-Ganz insertion, initial presenting symptom, duration between insertion and first evidence of PA injury, inciting event, site of pseudoaneurysm, treatment and outcome.

RESULTS

Forty-one patients were identified from 27 papers. In the reviewed population, 87.8% were older than 60 years of age and 82.9% were females. Fifty-one percent of the patients had an episode of hemoptysis on the day of Swan-Ganz catheter insertion. Ninety-seven percent of the patients had PA pseudoaneurysm in the right pulmonary circulation. The admission-to-discharge mortality rate in the reviewed cohort was 15%. Cause of death in 22% of the cases was hemoptysis, while non-catheter related complications were responsible for the remaining deaths.

CONCLUSION

PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter based or surgical interventions.

[Severe haemoptysis revealing a Rasmüssen aneurysm]

INTRODUCTION

The incidence of pulmonary tuberculosis is actually increasing. In active tuberculosis, an aneurysm of the pulmonary artery represents a frequent cause of haemoptysis. In cases of tuberculosis sequelae, the origin of the haemoptysis is often a bronchial artery.

CASE REPORT

We describe the case of a man from Morocco who presented with severe haemoptysis. He was cachectic, had a fever and his chest X-ray showed a cavity in the left lower lobe. CT angiography (MDCTA) showed a Rasmüssen aneurysm of the pulmonary artery. This was occluded with coils, and multi-drug therapy against Mycobacterium tuberculosis was initiated as soon as tuberculosis was diagnosed. Two months later, there was no recurrence of the haemoptysis and repeat the MDCTA showed no opacification of the aneurysm.

CONCLUSIONS

In patients with severe haemoptysis and evidence of active pulmonary tuberculosis, MDCTA may allow correct identification of the bleeding origin. In our case, the management of the pulmonary aneurysm relied upon pulmonary artery vasoocclusion. This treatment allowed us to wait for the antituberculosis treatment to be effective and reduces the need for a thoracic surgery.