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November 1975

Misplacement of Central Venous Pressure Catheters and Unilateral Pulmonary Edema

Author Affiliations

From the Nuclear Medicine and Radiology Services, St. Louis Veterans Administration Hospital and the departments of medicine and radiology, St. Louis University School of Medicine, St. Louis. Dr. Royal is now at the Rhode Island Hospital, Providence, RI.

Arch Intern Med. 1975;135(11):1502-1505. doi:10.1001/archinte.1975.00330110092012

The pathophysiology of pulmonary edema has been extensively studied and reviewed.1 Predominantly unilateral pulmonary edema has been reported infrequently as a result of patient positioning,2,3 left ventricular failure,4,5 increased intracranial pressure,6 preexisting lung disease,7 congenital heart disease,8,9 rapid reexpansion of an ipsilateral pneumothorax,10-14 or reexpansion of a contralateral pneumothorax after acute left-sided heart failure.15 In contrast, misplacement of central venous catheters is frequent, occurring in 25% to 38% of the cases in which the catheter was believed to be properly placed.16-19 To our knowledge, misplacement of central venous monitoring catheters into a pulmonary artery has not been reported previously. We have observed two catheters in this aberrant position. In addition, in the case reported here, unilateral pulmonary edema developed following placement of the "central venous" catheter in the ipsilateral pulmonary artery. Experiments in dogs to explore possible mechanisms of pulmonary edema following catheter placement in the pulmonary artery are also