Spontaneous Rupture of a Mediastinal Bronchial Artery Aneurysm Induced by Anticoagulant Agent

Abstract

Nontraumatic spontaneous rupture of a bronchial artery aneurysm is rarely seen. In this report, we described such a phenomenon in a patient induced by usage of anticoagulant agent. The patient had no antecedent history of trauma, hypertension, or apparent aortic pathology. The patient who had been taking low-molecular-weight heparin and warfarin to treat deep vein thrombosis complained of a sudden upper abdomen pain with shortness of breath and hypoxemia. The patient was diagnosed and treated for an acute hemomediastinum caused by a ruptured bronchial artery aneurysm. If the patient had continued to take the anticoagulant antithrombotic drugs, it may cause a more virulent bleeding. Taken together, CT angiography is a useful diagnosis tool for patients with sudden chest pain and abdominal pain, and rare cause should be considered.

Bronchial artery aneurysm presenting with epigastric pain that improves with vomiting

“…Bronchial aneurysm is a rare disease with few cases reported to date. San Norberto et al reported 108 cases of bronchial aneurysm, including nine cases of mediastinal haematoma associated with ruptured bronchial aneurysm, excluding our case 1–10 . For bronchial aneurysms as a whole, symptoms were predominantly non‐specific, including bloody sputum (30.5%) and chest pain (9.3%), and 10% of cases were asymptomatic.…”

“…San Norberto et al reported 108 cases of bronchial aneurysm, including nine cases of mediastinal haematoma associated with ruptured bronchial aneurysm, excluding our case. [1][2][3][4][5][6][7][8][9][10] For bronchial aneurysms as a whole, symptoms were predominantly non-specific, including bloody sputum (30.5%) and chest pain (9.3%), and 10% of cases were asymptomatic. Chest and epigastric pain were present in all 10 patients with mediastinal haematoma, but seven (70%) had gastrointestinal symptoms such as epigastric discomfort and dysphagia (Table 1).…”

Role of vascular remodeling in atherosclerosis and aortic aneurysm

“…244,245 A few clinical cases have been reported in which the use of anticoagulants induced spontaneous rupture of bronchial artery aneurysms in patients who took heparin and VKAs, and did not have an apparent aortic pathology. 246 Additionally, VKAs promote many effects similar to what has been observed in aneurysm pathology. In a mouse model of atherosclerosis, high dose VKAs induce a vulnerable atherosclerotic plaque phenotype with elastin breaks.…”