Quiz #9: Where is the tip of the PA line?

Question: Based on the CXR and PA line pressure trace, what is the location of the PA line tip? (Clue: The PA pressure trace holds the answer. Chest Xray helps to corroborate.)

Answer: RV outflow tract.

Rationale: PA pressure has a ventricular trace with a pressure of 55/1. If you enlarge and see, pressure trace is typical of a ventricular pattern. So, the line tip is in the RV. But, in the CXR, it is high up in the RV. Combining the two findings, the line tip has to be below the valve i.e. RVOT.

Of course, this patient has elevated PA pressure at ~50% systemic level.