An unusual manifestation of pulmonary artery perforation during pulmonary artery catheter insertion.

P ULMONARY ARTERY balloon-tipped catheters are commonly inserted in critically ill patients as a source of physiologic data useful in planning management and evaluating the efficacy of treatment. Pulmonary artery perforation with resultant massive hemoptysis is a known complication of the use of these catheters, with an occurrence of 0.064% in one large series.’ The perforations with hemorrhage reported in this series occurred during the period after insertion rather than during actual insertion of the catheter. Various mechanisms for pulmonary artery injury during the insertion of these catheters have been proposed,* but no incidence for pulmonary artery injury during insertion has been reported. A case is reported which describes the immediate production of organized blood clots after pulmonary artery rupture during insertion and positioning of a pulmonary artery balloon-tipped catheter.