Pulmonary Artery-Bronchial Fistula

نویسنده

  • Miguel Fiol
چکیده

experience recently. In our case, a 48-year-old man with acute myocardial infarction had a 7F Swan-Ganz catheter placed in the pulmonary artery. Intracardiac knotting was discovered and the catheter was withdrawn slightly leaving the tip in the pulmonary artery. The second day, pericarditis was detected and on the fourth, a small left pleural effusion appeared on roentgenogram. To exclude a possible pulmonary thromboembolism, after the injection of 0.8 ml of saline solution in the balloon, a representative tracing of wedging was recorded,1 followed by an injection of 7 ml of contrast at a flow rate of approximately 2 mI/sec. The patient had an immediate attack of coughing and produced bloody sputum. The chest roentgenogram revealed a parenchymatous collection of contrast material near the tip of the catheter; bronchogram of the left bronchial tree was completely identical to the one shown in the report by Rubin and Puckett (Fig 1). Several mechanisms have been proposed to explain the perforation of the pulmonary artery associated with the use of Swan-Canz catheters, but the cause remains unclear.2 In our patient, the catheter tip was advanced deeply into a small pulmonary branch and perforation may have been caused by increasing pressure on the lateral walls of the artery when the balloon was reinfiated and/or the tip of the catheter deflected into the wall with the balloon inflated; the shearing effect of the tip against the wall, promoted by the rapid injection of contrast material, may have perforated the wall of the vessel, which could be a different mechanism than the one postulated by Rubin and Puckett. However, we were unable to

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تاریخ انتشار 2005