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Case Reports
. 2019 Apr 27;19(1):31.
doi: 10.1186/s12880-019-0333-5.

Intercostal artery pseudoaneurysm following thoracentesis: multi-modal imaging and treatment

Kaitlyn P Casper  1 , Paul J Sanchirico  2 , David C Pfeiffer  3
Affiliations
Case Reports

Intercostal artery pseudoaneurysm following thoracentesis: multi-modal imaging and treatment

Kaitlyn P Casper et al. BMC Med Imaging. .

Abstract

Background: A pseudoaneurysm occurs as the result of a contained rupture of an arterial wall, yielding a perfused sac that communicates with the arterial lumen. Pseudoaneurysm of an intercostal artery is an extremely rare event but it carries with it a significant risk of rupture and subsequent hemothorax. It must be considered as a potential complication of thoracentesis.

Case presentation: Here, we report a rare case of an intercostal artery pseudoaneurysm following thoracentesis in an 82-year old male. The patient presented with respiratory distress 1 day after a therapeutic thoracentesis had been performed. Computed tomography (CT) with contrast revealed a left intercostal pseudoaneurysm with hemothorax and adjacent compressive atelectasis. Doppler ultrasound revealed bidirectional blood flow in the pseudoaneurysm sac. An intercostal arteriogram and thoracic aortogram aided in confirmation of the pseudoaneurysm and successful treatment with coil embolization.

Conclusions: An intercostal pseudoaneurysm complication following thoracentesis is very rare but important to rule out as a possible cause of hemothorax after the procedure. Capturing this finding with the aid of multiple imaging modalities allowed for diagnostic certainty and rapid treatment with coil embolization, leading to a successful patient recovery.

Keywords: Coil embolism; Hemothorax; Intercostal artery; Multi-modal imaging; Pseudoaneurysm; Thoracentesis.

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Conflict of interest statement

Authors’ information

KPC is a medical student in the WWAMI Medical Education Program at the University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195. PJS is a diagnostic radiologist and vascular and interventional radiologist at St Joseph Regional Medical Center, 415 6th St, Lewiston, ID, 83501. DCP is a professor in the Department of Biological Sciences and the WWAMI Medical Education Program at the University of Idaho, 875 Perimeter Drive, Moscow, ID, 83844–3051, USA.

Ethics approval and consent to participate

Not applicable.

Consent for publication

The patient has provided written informed consent to the clinical details including images of the case being submitted and published as a case report.

Competing interests

The authors declare they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
AP (anteroposterior) chest plain radiograph in an 82-year old male, following thoracentesis. Note the significant pleural effusion with compressive atelectasis (arrow) in the left lower hemithorax
Fig. 2
Fig. 2
IV contrast-enhanced computed tomography (CT) image, axial projection. The left intercostal artery pseudoaneurysm (white arrow) with hemothorax (asterisks) and adjacent compression atelectasis (black arrow) can be seen
Fig. 3
Fig. 3
Grey scale ultrasound image of the left intercostal artery pseudoaneurysm. Arrows delineate the pseudoaneurysm
Fig. 4
Fig. 4
Color Doppler ultrasound image of the intercostal artery pseudoaneurysm. Note the characteristic yin-yang (red-blue) blood flow present in the pseudoaneurysm
Fig. 5
Fig. 5
a Selective digital subtraction angiogram of the intercostal artery pseudoaneurysm (arrow). b IV contrast-enhanced computed tomography (CT) image, coronal projection, depicting the pseudoaneurysm (arrow)
Fig. 6
Fig. 6
Digital subtraction angiogram image demonstrating successful occlusion of the intercostal artery pseudoaneurysm by means of coil embolization. The coils are clearly visible (arrows)
See this image and copyright information in PMC

References

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