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Review
. 2015 Nov 24:10:58.
doi: 10.1186/s13017-015-0052-3. eCollection 2015.

Massive hemothorax due to inferior phrenic artery injury after blunt trauma

Makoto Aoki  1 , Kei Shibuya  2 , Minoru Kaneko  3 , Ayana Koizumi  2 , Masato Murata  3 , Jun Nakajima  3 , Shuichi Hagiwara  3 , Masahiko Kanbe  3 , Yoshinori Koyama  2 , Yoshito Tsushima  2 , Kiyohiro Oshima  3
Affiliations
Review

Massive hemothorax due to inferior phrenic artery injury after blunt trauma

Makoto Aoki et al. World J Emerg Surg. .

Abstract

Injury to the inferior phrenic artery after blunt trauma is an extremely rare event, and it may occur under unanticipated conditions. This case report describes an injury to the left inferior phrenic artery caused by blunt trauma, which was complicated by massive hemothorax, and treated with transcatheter arterial embolization (TAE). An 81 year-old female hit by a car while walking at the traffic intersection was transferred to the emergency department, computed tomography scanning revealed active extravasations of the contrast medium within the retrocrural space and from branches of the internal iliac artery. The patient underwent repeated angiography, and active extravasation of contrast medium was observed between the retrocrural space and the right pleural space originating from the left inferior phrenic artery. The injured left inferior phrenic artery was successfully embolized with N-butyl cyanoacrylate, resulting in stabilization of the patient's clinical condition. Inferior phrenic artery injury should be recognized as a rare phenomenon and causative factor for hemothorax. TAE represents a safe and effective treatment for this complication and obviates the need for a thoracotomy.

Keywords: Blunt trauma; Inferior phrenic artery; N-butyl cyanoacrylate; Transcatheter arterial embolization.

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Figures

Fig. 1
Fig. 1
a Enhanced CT revealed contrast material extravasation within the retrocrural space on arterial phase (arrow). b Enhanced CT revealed contrast material extravasation above the pubic bone fractures on arterial phase (arrow)
Fig. 2
Fig. 2
Enhanced CT showed the extension of the hematoma from within the retrocrural space to the right pleural space, and the extravasation of the retrocrural space (arrow)
Fig. 3
Fig. 3
a Digital subtraction angiography of the left inferior phrenic artery angiography demonstrated contrast material extravasation (arrow). b After transcatheter arterial embolization, N-Butyl Cyanoacrylate (NBCA) and Lipiodol were detected (arrow)
See this image and copyright information in PMC

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