Ruptured intercostal artery pseudoaneurysm: a rare cause of acute back pain

Post-thoracotomy intercostal artery pseudoaneurysm manifesting as a chest wall metastasis

Intercostal artery pseudoaneurysm (IAP) represents an extremely rare vascular abnormality developing after an insult to the vascular wall with blood collection within the vascular wall layers and subsequent dilatation. Treatment options, apart from observation, include embolization, endovascular stenting, and surgical correction. We describe the case of a 73-year-old male patient with colonic adenocarcinoma pulmonary metastasis. Repetitive wedge resections and a right lower lobectomy were performed to remove multiple metastatic lesions. At follow-up assessment, the patient reported localized thoracotomy site pain progressing with time and unresponsive to oral analgesics. Chest computed tomography (CT) revealed a pseudoaneurysm of 4-cm diameter of the right 5th intercostal artery. The patient underwent embolization of the lumen and was discharged from the hospital after 24 h. Successive CT re-assessment checks were unremarkable.

Intercostal Artery Aneurysmosis Secondary to Chronic Cocaine Abuse

Intercostal artery aneurysms are rare entities usually seen in connective tissue disorders and inflammatory conditions and syndromes like Ehlers-Danlos syndrome, Kawasaki’s disease, and neurofibromatosis. Spontaneous development of intercostal aneurysm is rare and the presence of multiple aneurysms/aneurysmosis is exceedingly rare. Although there have been a few case reports on aortic aneurysm, coronary artery aneurysms and many on ruptured cerebral aneurysms, we could not find a single case of spontaneous intercostal artery aneurysm secondary to chronic cocaine abuse. We report an exceedingly rare case of intercostal artery aneurysmosis presumably secondary to long-term cocaine abuse. Intercostal artery aneurysm is the least common visceral aneurysm and given the very limited literature on this subject, the pathogenesis is poorly understood.

Massive hemothorax caused by intercostal artery pseudoaneurysm:a case report

BACKGROUND

Intercostal artery pseudoaneurysm is rare and at the risk of rupture. The aetiology is always reported to be iatrogenic and traumatic injury. Embolisation is the most common therapeutic method. Here, we report a case of spontaneous intercostal artery pseudoaneurysm and cured by combining covered stent grafting and surgical management.

CASE PRESENTATION

A 60-year-old man complained of acute right back pain for 5 h. Computed tomography showed right massive hemothorax and a giant mass with distinct feeding vessel originated from the thoracic aorta within the right hemithorax. Thoracocentesis was performed, and then a covered stent was positioned across the origin of the feeding vessel. The patient was diagnosed with intercostal artery pseudoaneurysm. Finally, we successfully resected the pseudoaneurysm and ligated the proximal part of the artery. Histologic examination have proved the diagnosis. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. There is no recurrence reported during follow-up.

CONCLUSIONS

Spontaneous intercostal artery pseudoaneurysm is extremly rare. Delayed hemothorax due to rupture of the pseudoaneurysm may occur years after the formation. Early diagnosis is important and a combined treatment of endovascular intervention and surgical management is feasible, especially for the case of ruptured large tumour-like mass presentation of the pseudoaneurysm.