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J Thorac Cardiovasc Surg 2002;124:1230-1232
© 2002 The American Association for Thoracic Surgery

Brief Communications

Percutaneous treatment of a ruptured intercostal aneurysm presenting as massive hemothorax in a patient with type I neurofibromatosis

J. Dominguez, MDa, C. Sancho, MDa, E. Escalante, MDa, J. R. Morera, MDb, J. A. Moya, MDb, R. Bernat, MDc Barcelona, Spain

From the Departments of Vascular Radiology,a Thoracic Surgery,b and Pathology,c Hospital "Princeps d'Espanya," Barcelona, Spain.

Received for publication Feb 7, 2002. Accepted for publication Feb 18, 2002. Address for reprints: Department de Radiologia Vascular, Hospital "Princeps d'Espanya," Feixa Llarga s/n, 08907—L'Hospitalet de Llobregat, Barcelona, Spain.

The first 20% of the full text of this article appears below.

Acute hemothorax caused by intercostal artery aneurysm rupture is a life-threatening complication of type I neurofibromatosis (NF I), which was successfully treated with percutaneous embolization.

Clinical summary

A 44-year-old man with NF I had sudden pleuritic pain and dyspnea 36 hours before admission to our hospital. Previously, he had been admitted to another center, where massive hematic pleural effusion was detected, and chest tube drainage yielded 1800 mL of blood. There was no past history of trauma, surgical intervention, or rib fracture.

On arrival at our hospital, the patient was conscious and had an arterial pressure of 114/69 mm Hg, a heart rate of 120 beats/min, an oxygen saturation of 92%, a hematocrit value of 21%, and a hemoglobin value of 7.1 g/dL. The chest x-ray film showed massive left pleural effusion and severe high dorsal scoliosis (Figure 1). Auscultation revealed left hemithorax hypophonesis.


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  		Fig. 1. Posteroanterior plain chest film shows massive left pleural effusion and severe high dorsal scoliosis.

 
Because of the severity of the clinical picture, thoracic aortography was urgently performed, and a lesion suspected to be aneurysmal was detected in the upper third of the left hemithorax. A 5-mL total volume of low osmolality contrast medium at a rate of 1 mL/s was selectively injected into the fourth left intercostal artery with a multipurpose 5F catheter (Biosphere Medical, Louvres, France), confirming the presence of a 1-cm-diameter aneurysm located 2 cm from the ostium (Figure 2, A. . . [Full Text of this Article]




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