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Case Reports
. 2024 Jun 16;18(1):280.
doi: 10.1186/s13256-024-04602-3.

Spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support: a case report

Kazuto Ohtaka  1   2 , Setsuyuki Ohtake  3 , Yu Ishii  3 , Saya Kaku  3 , Yuta Takeuchi  3 , Tomoko Mizota  3 , Yoshiyuki Yamamura  3 , Masaomi Ichinokawa  3 , Tatsuya Yoshioka  3 , Eiji Tamoto  3 , Katsuhiko Murakawa  3 , Koichi Ono  3 , Tatsuya Kato  4
Affiliations
Case Reports

Spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support: a case report

Kazuto Ohtaka et al. J Med Case Rep. .

Abstract

Background: Intercostal artery bleeding often occurs in a single vessel; in rare cases, it can occur in numerous vessels, making it more difficult to manage.

Case presentation: A 63-year-old Japanese man was admitted to the emergency department owing to sudden chest and back pain, dizziness, and nausea. Emergency coronary angiography revealed myocardial infarction secondary to right coronary artery occlusion. After intra-aortic balloon pumping, percutaneous coronary intervention was performed in the right coronary artery. At 12 hours following percutaneous coronary intervention, the patient developed new-onset left anterior chest pain and hypotension. Contrast-enhanced computed tomography revealed 15 sites of contrast extravasation within a massive left extrapleural hematoma. Emergency angiography revealed contrast leakage in the left 6th to 11th intercostal arteries; hence, transcatheter arterial embolization was performed. At 2 days after transcatheter arterial embolization, his blood pressure subsequently decreased, and contrast-enhanced computed tomography revealed the re-enlargement of extrapleural hematoma with multiple sites of contrast extravasation. Emergency surgery was performed owing to persistent bleeding. No active arterial hemorrhage was observed intraoperatively. Bleeding was observed in various areas of the chest wall, and an oxidized cellulose membrane was applied following ablation and hemostasis. The postoperative course was uneventful.

Conclusion: We report a case of spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support that was difficult to manage. As bleeding from numerous vessels may occur during antithrombotic therapy, even without trauma, appropriate treatments, such as transcatheter arterial embolization and surgery, should be selected in patients with such cases.

Keywords: Case report; Extrapleural hematoma; Extravasation; Spontaneous intercostal artery bleeding; Transcatheter arterial embolization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography scan showing a large left extrapleural hematoma and multiple-vessel bleeding within the hematoma. Yellow numbers indicate the rib numbers. White arrows indicate the parietal pleura. White arrowheads indicate contrast extravasation
Fig. 2
Fig. 2
Emergency angiography showing contrast leakage from the left 6th to 11th intercostal arteries. Transcatheter arterial embolization was performed on these vessels. Black arrows indicate contrast extravasation
Fig. 3
Fig. 3
Contrast-enhanced computed tomography scan following transcatheter arterial embolization, revealing a re-enlarged extrapleural hematoma, multiple-vessel bleeding (white arrowheads), and atelectasis of the left lung (white arrows). Yellow numbers indicate the rib numbers. White arrows indicate the left lung. White arrowheads indicate contrast extravasation
See this image and copyright information in PMC

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