Pulmonary haemorrhage following Swan-Ganz catheterization in a patient without severe pulmonary hypertension.

A case of haemoptysis following pulmonary artery rupture by a Swan-Ganz catheter is described. The most likely pathogenesis appears to be spontaneous migration of the catheter into a peripheral vessel due to a redundant loop in the right ventricle. This, in association with possible hyperreactivity of the vessel, caused a tight fit; on inflation of the balloon a shearing force ruptured the vessel, with subsequent haemoptysis. Severe pulmonary hypertension does not appear to be an absolute perequisite for the occurrence of this rare but potentially fatal complication. The most important preventive measures are the early removal of any redundant loop of the catheter in the right ventricle seen on the radiograph taken after insertion, and gradual inflation of the balloon.