A case of pulmonary artery rupture induced by balloon occlusion pulmon
ary angiography (BOPA) is reported. A flow-directed pulmonary artery c
atheter had been inserted for hemodynamic monitoring in a septic shock
patient complicated by acute respiratory distress syndrome. To check
for pulmonary damage, BOPA was performed immediately after hemodynamic
measurement. Just as the hand injection of contrast medium was ending
, the patient began to cough and a small amount of hemoptysis was obse
rved. The angiogram showed the extravasation of contrast medium from t
he distal pulmonary artery to the situation of catheter tip. Pulmonary
hemorrhage was controlled with mechanical ventilatory support with 10
cmH2O positive end-expiratory pressure and no specific therapy was re
quired. This complication should be kept in mind and using a power inj
ector to avoid injurious transient high pressure pulse is recommended.