Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Nov;36(6):639-642.
doi: 10.1007/s12055-020-01004-0. Epub 2020 Jul 21.

First case of cough-induced combined intercostal artery rupture with partial diaphragm tear

Niravkumar K Sangani  1 , Santosh Mathew Naliath  1
Affiliations
Case Reports

First case of cough-induced combined intercostal artery rupture with partial diaphragm tear

Niravkumar K Sangani et al. Indian J Thorac Cardiovasc Surg. 2020 Nov.

Abstract

We describe a case of vigorous cough-induced left intercostal artery rupture with partial diaphragmatic tear in a 60-year-old obese male with chronic obstructive pulmonary disease. He presented with left hemothorax, a rapidly spreading chest and abdominal wall hematoma, and progression of anemia. Computed tomography (CT) scan revealed a bleeding focus from the left 8th intercostal artery. CT-guided surface marking of the bleeding point was done over the chest wall. The patient underwent open thoracotomy with drainage of clotted hemothorax and ligation of bleeding intercostal artery. Incidentally, a partial diaphragm tear was detected during the surgery which was repaired. The combined presentation of cough-induced intercostal artery rupture with partial diaphragm tear is not reported earlier. Awareness of these co-existing pathologies can facilitate timely diagnosis and appropriate life-saving management.

Keywords: COPD; Cough; Diaphragm; Hematoma; Hemothorax; Intercostal artery rupture.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Preoperative computed tomography of the chest showing bleeding of the left 8th intercostal artery with left hemothorax and left chest wall hematoma
Fig. 2
Fig. 2
Preoperative chest, abdominal, and pelvic hematoma with CT-guided surface marking of the site of the bleeding artery
Fig. 3
Fig. 3
Intraoperative image showing the partial diaphragm tear
See this image and copyright information in PMC

References

    1. Dua A, Dua A, Jechow S, Desai SS, Kuy S. Idiopathic spontaneous rupture of an intercostal artery. WMJ. 2014;113:116–118. - PubMed
    1. Salmi R, Gaudenzi P, Ricci F, et al. Sudden acute thoracic pain and hypovolemic shock as a presentation of spontaneous rupture of intercostal artery: a case report. J Am Geriatr Soc. 2012;60:371–373. doi: 10.1111/j.1532-5415.2011.03802.x. - DOI - PubMed
    1. Yu WY, Wang CP, Ng KC, Chen WK, Tzeng IH. Successful embolization of a ruptured intercostal artery after violent coughing. Am J Emerg Med. 2006;24:247–249. doi: 10.1016/j.ajem.2005.09.004. - DOI - PubMed
    1. Jang JY, Lim YS, Woo JH, Jang JH. Spontaneous rupture of intercostal artery after severe cough. Am J Emerg Med. 2015;33:131.e1–131.e3. doi: 10.1016/j.ajem.2014.06.033. - DOI - PubMed
    1. Durey A, Kim YS, Kim AJ. Spontaneous intercostal artery bleeding in a hemodialysis patient. Hemodial Int. 2017;21:E76–E78. doi: 10.1111/hdi.12576. - DOI - PubMed

Publication types

LinkOut - more resources