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Case Reports
. 2021 Apr-Jun;14(2):111-116.
doi: 10.4103/JETS.JETS_157_20. Epub 2021 Apr 27.

Role of Intercostal Artery Embolization in Management of Traumatic Hemothorax

Rahul Lohan  1 , Kheng Song Leow  2 , Marc Weijie Ong  3 , Tiong Thye Goo  3 , Sundeep Punamiya  4
Affiliations
Case Reports

Role of Intercostal Artery Embolization in Management of Traumatic Hemothorax

Rahul Lohan et al. J Emerg Trauma Shock. 2021 Apr-Jun.

Abstract

Intercostal artery bleeding from trauma can result in potentially fatal massive hemothorax. Traumatic hemothorax has traditionally been treated with tube thoracostomy, video-assisted thoracoscopic surgery, or thoracotomy. Transcatheter arterial embolization (TAE), a well-established treatment option for a variety of acute hemorrhage is not widely practiced for the management of traumatic hemothorax. We present 2 cases of delayed massive hemothorax following chest trauma which were successfully managed by transarterial embolization of intercostal arteries. The published studies are reviewed and a systematic approach to the selection of patients for TAE versus emergency thoracotomy is proposed.

Keywords: Chest trauma; hemothorax; intercostal artery; transarterial embolization.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Stabbing injury. Arterial (a) and delayed phase (b) images from a CT demonstrate small pseudoaneurysm (white arrow) arising from the anterior intercostal artery. The pseudoaneurysm was also localized on ultrasound (c), however, after 2 h (d) it had spontaneously thrombosed. Follow up chest radiograph (e) and CT (f) obtained 24 h after the injury, show large right hemothorax. Selective angiography (g) of the anterior intercostal artery shows small focus of contrast extravasation. Angiographic image (h) following embolization with mixture of n butyl cyanoacrylate and lipiodol
Figure 2
Figure 2
Delayed hemothorax following fall. Initial chest radiograph (a) did not show any pleural fluid. Chest radiograph (b) obtained 9 days later, shows almost complete white out of the left hemithorax from large hemothorax. Contrast-enhanced CT images (c and d) demonstrate contrast extravasation from the posterior intercostal artery and multiple displaced rib fractures. Selective angiography images before (e) and after (f) embolization with n-butyl cyanoacrylate -lipiodol mixture
Figure 3
Figure 3
Previously published case reports and studies on transarterial embolization of intercostal artery(ies) for traumatic hemothorax
Figure 4
Figure 4
Ar tery of Adamkiewicz. Posterior intercostal ar tery angiogram (from case 2) demonstrates the characteristic hairpin turn (arrow) at its junction with the anterior spinal artery
See this image and copyright information in PMC

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