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Case Reports
. 2020 Mar 31;33(3):448-450.
doi: 10.1080/08998280.2020.1738853. eCollection 2020 Jul.

Embolization of a hemorrhaging abdominal plexiform neurofibroma

Aaminah F Azhar  1 , Joseph Scott H Bittle  2 , Thomas J Kwarcinski  2 , Jonathan R Hinshelwood  3
Affiliations
Case Reports

Embolization of a hemorrhaging abdominal plexiform neurofibroma

Aaminah F Azhar et al. Proc (Bayl Univ Med Cent). .

Abstract

In rare instances, neurofibromas may spontaneously bleed. In this case, a 21-year-old woman with a known cutaneous neurofibroma presented with a rapidly enlarging right abdominal wall mass. After embolization of a focal pseudoaneurysm and the right internal mammary artery, her hemoglobin continued to decline. The right internal mammary artery and inferior epigastric artery were then embolized. The patient eventually underwent mass resection, hematoma evacuation, and flap reconstruction. Final surgical pathology confirmed the expected diagnosis of plexiform neurofibroma. The Schwann cells of plexiform neurofibromas, present in approximately 50% of patients with neurofibromatosis-1, have invasive and angiogenic properties, often resulting in hemorrhage.

Keywords: Embolization; hemorrhage; interventional radiology; neurofibromatosis; plexiform neurofibroma; pseudoaneurysm.

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Figures

Figure 1.
Figure 1.
The abdominal wall mass at the time of excision.
Figure 2.
Figure 2.
(a) Computed tomography of the abdomen and pelvis on admission with active extravasation within a large right abdominal wall mass. (b) Magnetic resonance imaging of the abdomen and pelvis in 2005 demonstrating a heterogeneous mass within the right abdominal wall, compatible with a plexiform neurofibroma.
Figure 3.
Figure 3.
Angiography showing (a) a right internal mammary artery pseudoaneurysm; (b) persistent flow within the inferior epigastric artery prior to repeat embolization; and (c) persistent flow within the right internal mammary artery prior to repeat embolization.
See this image and copyright information in PMC

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