CTICasesSelective Left Pulmonary Edema due to Impella RP Malposition
Imaging findings
Chest radiograph demonstrates a right-sided Impella RP circulatory assist device extending from the inferior vena cava, through the right heart chambers, with the distal catheter tip positioned selectively within the left pulmonary artery. Asymmetric, dense alveolar consolidation and edema are localized to the left lung, while the right lung remains relatively clear.
Key takeaways
Malposition of a right-sided Impella RP catheter tip too far into the left pulmonary artery can result in selective left-sided pulmonary hyperperfusion. This causes unilateral hydrostatic pulmonary edema on the left that can be mistaken for aspiration or pneumonia on chest radiographs. Correcting the catheter tip's position back into the main pulmonary artery resolves the asymmetric congestion.
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