2017 Volume 31 Issue 6 Pages 709-716
A 72-year-old woman rapidly developed hemoptysis, hypoxia, and low blood pressure during pulmonary artery catheter (PAC) insertion as a preoperative examination for mitral regurgitation. The patient was emergently intubated, put on one-lung ventilation, and administered a vasopressor intravenously. Contrast-enhanced CT and pulmonary angiography revealed massive extravasation from the ruptured right lower lobar branch (A8) to both the airway and pleural space. We transported the patient to the operating room immediately while pumping fluids and blood, and opened the chest as soon as anesthesia had been administered. Intraoperative examination showed blood welling up from the thoracic cavity, and the right lower and middle lobes were solid and dark purple. The hilum was controlled with a vascular clamp, and percutaneous cardiopulmonary support (PCPS) was administered while resuscitation was being carried out, and then the bi-lobectomy was promptly completed. Consequently, the patient's hemodynamics stabilized and PCPS could be withdrawn immediately after surgery. She did not show any neurologic sequelae or recurrent hemorrhage, and could be discharged after cardiopulmonary rehabilitation. Pulmonary artery injury is a rare but often fatal complication of PAC. If massive hemorrhage cannot be controlled conservatively, we should not hesitate to perform surgical intervention, which may offer the best chance for survival. Moreover, multidisciplinary support, PCPS that might control bleeding by reducing the pulmonary blood flow, for example, would be essential to rescue the patient with pulmonary artery perforation of PAC.
