Swan-Ganz Catheter-Induced Pulmonary Artery Pseudoaneurysm Formation Maurice R. Poplausky, MD, Grigory Rozenblit, MD, John H. Rundback, MD, Gastone Crea, MD, Shekher Maddineni, MD, Robert Leonardo, MD  CHEST  Volume 120, Issue 6, Pages 2105-2111 (December 2001) DOI: 10.1378/chest.120.6.2105 Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 1 A portable chest radiograph demonstrating the right jugular vein Swan-Ganz catheter tip to be wedged in a right lower lobe PA (white arrow). CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 2 Image from a right PA angiogram (top) showing a faint extravascular collection (arrows) adjacent to the right lower lobe PA. The pseudoaneurysm is visualized much better after a selective catheterization arteriogram of the pseudoaneurysm (bottom). CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 3 Postembolization digital subtraction angiography demonstrates complete occlusion of the pseudoaneurysm with sparing of the feeding vessel. The subtracted images of the coils within the pseudoaneurysm are easily seen (arrow). CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 4 Chest radiograph (top) and CT scan of the chest (middle and bottom) performed after embolization demonstrate an effusion (open arrow) and atelectasis (arrow heads) of the right lower lobe. The coils in the pseudoaneurysm are easily identified (curved arrows). CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 5 A chest radiograph performed 2 months after embolization shows the coils to be present (arrow) with complete resolution of the atelectasis and effusion. CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 6 An anterior-posterior portable chest radiograph demonstrating a new, right upper lobe, circumscribed infiltrate (large arrows) in a patient with a Swan-Ganz catheter (small arrows). CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 7 Early (top) and late (bottom) subtracted images of a right PA angiogram demonstrating an upper lobe PA pseudoaneurysm (arrow). The visceral pleural edge (open arrows) has been displaced from the chest wall (small arrows) by a large effusion. CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 8 A selective arteriogram of the feeding vessel demonstrates the pseudoaneurysm to be at the epicenter of the new infiltrate. CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 9 A postembolization right PA angiogram showing nonfilling of the coiled pseudoaneurysm. CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 10 Coils are seen in the middle of the infiltrate (arrows) on a postembolization chest radiograph. CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions

Figure 11 A right PA arteriogram (top) demonstrating a pseudoaneurysm (arrows) arising from the right middle lobe PA. A postembolization image (bottom) shows a partial occlusion of the pseudoaneurysm. CHEST 2001 120, 2105-2111DOI: (10.1378/chest.120.6.2105) Copyright © 2001 The American College of Chest Physicians Terms and Conditions