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BMC Medical Imaging

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Open Access 01-12-2019 | Ultrasound | Case report

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

Authors: Kaitlyn P. Casper, Paul J. Sanchirico, David C. Pfeiffer

Published in: BMC Medical Imaging | Issue 1/2019

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.

Cantey EP, Walter JM, Corbridge T, Barsuk JH. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med. 2016;22:378–85. https://doi.org/10.1097/MCP.0000000000000285.CrossRefPubMed

Schwartz LB, Clark ET, Gewertz BL. Anastomotic and other pseudoaneurysms. In: Rutherford RB, editor. Vascular surgery. 5th ed. Philadelphia: Saunders; 2000. p. 752–63.

Saad NEA, Saad WEA, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. RadioGraphics. 2005;25:S173–89. https://doi.org/10.1148/rg.25si055503.CrossRefPubMed

Atherton WG, Morgan WE. False aneurysm of an intercostal artery after thoracoscopic sympathectomy. Ann R Coll Surg Engl. 1997;79:229–30.PubMedPubMedCentral

Casas JD, Perendreu J, Gallart A, Muchart J. Intercostal artery pseudoaneurysm after a percutaneous biliary procedure: diagnosis with CT and treatment with transarterial embolization. J Comput Assist Tomogr. 1997;21:729–30.CrossRef

Bluebond-Langner R, Pinto P, Kim FJ, Hsu T, Jarrett TW. Recurrent bleeding from intercostal arterial pseudoaneurysm after retroperitoneal laparoscopic radical nephrectomy. Urology. 2002;60:1111. https://doi.org/10.1016/S0090-4295(02)01998-2.CrossRefPubMed

Aoki T, Okada A, Tsuchida M, Hayashi J. Ruptured intercostal artery pseudoaneurysm after blunt thoracic trauma. Thorac Cardiovasc Surg. 2003;51:346–7. https://doi.org/10.1055/s-2003-45512.CrossRefPubMed

Sekino S, Takagi H, Kubota H, Kato T, Matsuno Y, Umemoto T. Intercostal artery pseudoaneurysm due to stab wound. J Vasc Surg. 2005;42:352–6. https://doi.org/10.1016/J.JVS.2005.03.058.CrossRefPubMed

Fernandez Alonso S, Azcona CM, Heredero AF, de Cubas LR. Post-sternotomy intercostal artery pseudoaneurysm. Sonographic diagnosis and thrombosis by ultrasound-guided percutaneous thrombin injection. Interact Cardiovasc Thorac Surg. 2009;9:722–4. https://doi.org/10.1510/icvts.2009.208116.CrossRef

10.

Melloni G, Bandiera A, Crespi G, Zannini P. Intercostal artery pseudoaneurysm after computed tomography-guided percutaneous fine needle aspiration lung biopsy. J Thorac Imaging. 2012;27:W48–9. https://doi.org/10.1097/RTI.0b013e3182107430.CrossRefPubMed

11.

Lenders G, Van Schil P, Rodrigus I, Bosmans J. Intercostal artery pseudoaneurysm: a rare complication of transaortic transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg. 2012;15:550–2. https://doi.org/10.1093/icvts/ivs188.CrossRefPubMedPubMedCentral

12.

Gutierrez Romero DF, Barrufet M, Lopez-Rueda A, Burrel M. Ruptured intercostal artery pseudoaneurysm in a patient with blunt thoracic trauma: diagnosis and management. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2013-202019.

13.

Vajtai Z, Roy N. Intercostal artery pseudoaneurysm after ultrasound-guided liver biopsy: a case report and review of the literature. Ultrasound Q. 2015;31:63–5. https://doi.org/10.1097/RUQ.0000000000000074.CrossRefPubMed

14.

Mercaldi MPHCJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest. 2013;143:532–8. https://doi.org/10.1378/chest.12-0447.CrossRefPubMed

15.

Long SS, Johnson PT, Fishman EK. Intercostal artery pseudoaneurysm due to thoracentesis: diagnosis with three-dimensional computed tomographic angiography. J Comput Assist Tomogr. 2012;36:100–2. https://doi.org/10.1097/RCT.0b013e318243250a.CrossRefPubMed

16.

Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol. 2000;11:66–72.CrossRef

17.

Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA. 2009;301:415–24. https://doi.org/10.1001/jama.301.4.415.CrossRef

18.

Hartung MP, Grist TM, François CJ. Magnetic resonance angiography: current status and future directions. J Cardiovasc Magn Reson. 2011;13:19–29. https://doi.org/10.1186/1532-429X-13-19.CrossRefPubMedPubMedCentral

19.

Razek AAK, Denewer AT, Hegazy MAF, Hafez MTA. Role of computed tomography angiography in the diagnosis of vascular stenosis in head and neck microvascular free flap reconstruction. Int J Oral Maxillofac Surg. 2014;43:811–5. https://doi.org/10.1016/j.ijom.2014.03.014.CrossRefPubMed

20.

Delgado Almandoz JE, Romero JM, Pomerantz SR, Lev MH. Computed tomography angiography of the carotid and cerebral circulation. Radiol Clin N Am. 2010;48:265–81. https://doi.org/10.1016/j.rcl.2010.02.007.CrossRefPubMed

21.

Saba L. Digital subtraction angiography for the analysis of supraaortic vessels: what is its role nowadays. World J Radiol. 2011;3:147–51. https://doi.org/10.4329/wjr.v3.i6.147.CrossRefPubMedPubMedCentral

22.

Kramer U, Ernemann U, Fenchel M, Seeger A, Laub G, Claussen CD, Miller S. Pretreatment evaluation of peripheral vascular malformations using low-dose contrast-enhanced time-resolved 3D MR angiography: initial results in 22 patients. Am J Roent. 2011;196:702–11. https://doi.org/10.2214/AJR.10.5092.CrossRef

23.

Higashihara H, Osuga K, Ueguchi T, Onishi H, Tanaka H, Maeda N, Tomoda K, Tomiyama N. Usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics applied to description of extracranial arteriovenous malformations: initial experience. Eur J Radiol. 2012;81:1134–9. https://doi.org/10.1016/j.ejrad.2011.03.040.CrossRefPubMed

24.

Razek AA, Gaballa G, Megahed AS, Elmogy E. Time resolved imaging of contrast kinetics (TRICKS) MR angiography of arteriovenous malformations of head and neck. Eur J Radiol. 2013;82:1885–91. https://doi.org/10.1016/j.ejrad.2013.07.007.CrossRefPubMed

Title: Intercostal artery pseudoaneurysm following thoracentesis: multi-modal imaging and treatment
Authors: Kaitlyn P. Casper
Paul J. Sanchirico
David C. Pfeiffer
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Ultrasound
Computed Tomography
Computed Tomography
Hemothorax
Ultrasound
Published in: BMC Medical Imaging / Issue 1/2019
Electronic ISSN: 1471-2342
DOI: https://doi.org/10.1186/s12880-019-0333-5

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Case presentation

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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