Lateral Thoracic Artery Pseudoaneurysm as a Result of Penetrating Chest Trauma

Abstract

Pseudoaneurysms are potentially fatal complications of vascular trauma; however, they are rarely seen as the sole complication of penetrating injury. We present a case of a pseudoaneurysm with an associated arteriovenous fistula of the left lateral thoracic artery as a result of direct trauma from a knife stab. The patient presented only with a painful, swollen left pectoralis muscle. Upon diagnosis, he was taken to the interventional radiology suite and treated successfully with fluoroscopic guided coil embolization. Cases such as these are infrequent and should encourage more aggressive use of contrast enhanced computed tomography imaging for soft tissue injury, as a missed traumatic pseudoaneurysm may result in life-threatening hemorrhage.

Keywords: Computed tomography; Hemorrhage; Interventional radiology; Pseudoaneurysm; Thoracic Trauma; Trauma.

Figure 1

A 52 year old male status post stabbing with a traumatic left lateral thoracic artery pseudoaneurysm. Findings: A saccular, contrast-enhanced 1.4 (transverse) by 1.0 (antero-posterior) by 2.4 (craniocaudal) cm pseudoaneurysm (A) within the musculature of the left chest wall. In the surrounding soft tissue there is a heterogeneous fluid collection measuring 6.7 (transverse) by 9.4 (craniocaudal) cm, suggested of hematoma formation. Demonstrated are coronal (a), sagittal (b) and axial (c) views. Technique: GE Healthcare Discovery CT 750HD™ chest computed tomography scan enhanced with 300 cc of intravenous iohexol solution (1.25 mm slice thickness, 5060 mAs, 120 kVp).

Figure 2

A 52 year old male status post stabbing with a traumatic left lateral thoracic artery pseudoaneurysm. Findings: Image: A lobulated pseudoaneurysm of the left lateral thoracic artery (A). Early venous filling his demonstrated (B) indicating arteriovenous fistula formation. Contrast is then seen returning into the central venous system (C). Technique: Spot radiograph during the venous phase of digital subtraction angiography sequence with injection of iohexol contrast solution through a Renegade Hi-flo microcatheter.

Figure 3

A 52 year old male status post stabbing with a traumatic left lateral thoracic artery pseudoaneurysm. Findings: The lateral thoracic artery (A) is cannulated and platinum microcoils have been deployed into the lateral thoracic artery (B). The lobulated pseudoaneurysm (C) is now excluded and devoid of flow. Technique: Spot radiograph during the arterial phase of digital subtraction angiography sequence with injection of iohexol contrast solution through a Renegade Hi-flo microcatheter.