A 48-Year-Old Man Presenting as an Emergency with Severe Back Pain, a Large Anterior Paravertebral Hematoma, and Spontaneous Rupture of the Right 9th Intercostal Artery Successfully Managed by Transcatheter Arterial Embolization: A Case Report

Abstract

Patient: Male, 48-year-old Final Diagnosis: Spontaneous intercostal arterial rupture Symptoms: Back pain Medication:— Clinical Procedure: — Specialty: Radiology Objective: Rare disease Background: The rupture of an intercostal artery is rare and is usually associated with trauma, neurofibromatosis type 1, or coarctation of the aorta. Transcatheter arterial embolization is a minimally invasive vascular surgical procedure used to control hemorrhage of an intercostal artery. This report describes a case of a 48-year-old man who presented with severe back pain. This was due to a large anterior paravertebral hematoma following the spontaneous rupture of the right 9 th intercostal artery. The rupture was successfully managed by transcatheter arterial embolization. Case Report: A 48-year-old man suddenly felt severe back pain while walking. He had no previous medical history and he had not experienced any external injury. On arrival, he was tachycardic and hypertensive. He did not have abnormal physical findings. His chest radiograph, 12-lead electrocardiogram, ultrasonography, and blood test findings were unremarkable. A chest computed tomography scan with contrast media was performed, which revealed a 4.3×2.7×7.0 cm mass, enhanced with contrast media, anterior to the 9 th vertebral body. The patient was diagnosed with spontaneous rupture of the right ninth intercostal artery. The lesion was embolized with 8 microcoils. The patient was discharged on the 8 th hospital day without complications. Conclusions: This report presents a rare case of the rupture of an intercostal artery in which no cause was identified. It highlights the role of imaging as an important diagnostic tool. Furthermore, this report shows the benefits of the timely use of emergency transcatheter arterial embolization, which in this instance resulted in a successful outcome.

Spontaneous Intercostal Artery Bleeding in a Patient With Buerger's Disease: A Case Report

“…Izumoto et. al reported less than 10 cases in the literature [ 1 ]. It is usually associated with conditions that cause the arterial walls to become weak.…”

“…Presenting symptoms for spontaneous ICA bleeding are variable and include chest pain, back pain, flank pain, neck pain, and dyspnea. About half of the reported patients developed hemodynamic instability and later went into shock [ 1 ]. The 10th and 11th ICAs have been reported as the most common location of spontaneous rupture [ 8 ].…”

“…The diagnosis of ICA rupture is usually based on the presence of a massive hemothorax or chest wall and/or retroperitoneal hematoma. Pleural fluid can be confirmed by performing chest radiography; however, CT scanning is an important diagnostic tool and is reported to be the preferred imaging modality in reported cases [ 1 , 12 ]. Contrast-enhanced CT and CTA are also useful, as they can detect the bleeding vessel involved as well as the associated complications.…”

“…Intercostal artery (ICA) bleeding is an uncommon yet potentially fatal condition, which can cause hemorrhagic shock and respiratory failure [ 1 ]. It is commonly associated with thoracic trauma and iatrogenic injuries.…”

“…Spontaneous ICA bleeding is extremely rare and is typically reported only in patients with certain underlying disorders, such as connective tissue diseases, liver cirrhosis, coarctation of the aorta, or uncontrolled hypertension [ 2 - 6 ]. Only a limited number of cases of spontaneous ICA bleeding in the absence of these underlying disorders have been reported in the literature [ 1 ].…”