Spontaneous rupture of the lateral thoracic artery in patients with liver cirrhosis

Abstract

Bleeding in patients with liver cirrhosis is primarily caused by gastroesophageal varix in association with extensive collateral circulation, portal hypertensive gastropathy, a Mallory-Weiss tear and peptic ulcer disease. The spontaneous rupture of an artery, as a result of coagulopathy, is extremely rare in patients with liver cirrhosis; however, we recently observed a case of a spontaneous rupture of the lateral thoracic artery in a 47 year-old male patient with alcoholic liver cirrhosis. The patient expired despite repeated transcatheter arterial embolization of the lateral thoracic artery and best supportive care. This is, to our knowledge, the first documented case of the spontaneous rupture of the lateral thoracic artery in a patient with liver cirrhosis.

Figure 1

The chest CT reveals a 13×7 cm sized hematoma in left chest wall.

Figure 2

The angiography shows active bleeding at the branch of left lateral thoracic artery (A). Thus embolization using gelfoam was performed (B).

Figure 3

Follow-up chest CT shows much increased hematoma at the same site.

Figure 4

The second angiography shows active bleeding from all the branches of left lateral thoracic artery and some lower intercostal arteries (A). Repeated embolization with contour particle was done (B).