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Li QC, Gong MH, Wan ZD. Axillary massage induced lateral thoracic artery pseudoaneurysm rupture: Case report. Int J Surg Case Rep 2024; 123:110214. [PMID: 39208618 DOI: 10.1016/j.ijscr.2024.110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/19/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Massage is a form of health care, but incorrect techniques can potentially harm the human body (Qin et al., 2023 [1]). While there have been no reported cases of lateral thoracic artery pseudoaneurysm and rupture induced by axillary massage, it is important to further explore how to address and prevent such potential risks. CASE PRESENTATION This case study highlights a rare occurrence where a 61-year-old female patient experienced a lateral thoracic artery pseudoaneurysm and ruptured as a result of an axillary massage. The patient, self-taught in Chinese medicine and massage, regularly rubbed the Jiquan points in her armpits to promote heart health, with each session lasting 30-60 min for two years. She presented with symptoms such as dizziness, palpitations, left armpit pain, and oedema, leading to her admission to a nearby hospital. Despite receiving blood transfusions, her symptoms did not improve, necessitating her to refer to our hospital. A CT angiography scan of her upper limb arteries revealed the presence of a left lateral thoracic artery pseudoaneurysm and rupture, resulting in subcutaneous hematoma in the left axilla, chest, and back. Following angiography, successful embolisation was performed. Three months after surgery, the patient regained full mobility and was free from pain in her left upper limb. CLINICAL DISCUSSION The armpit region contains a high concentration of nerves and blood vessels, making it crucial to have a thorough understanding of its anatomy and to use precise massage techniques. Damage to the axillary arteries can result in severe complications, which can be addressed through either open or endovascular interventional procedures. This article reviews existing literature and guides in managing these specific scenarios. CONCLUSION Caution should be exercised when performing an armpit massage, as a thorough understanding of the anatomy of the axillary area is crucial. Injury to the lateral thoracic artery is a potential risk during axillary massage, and in such cases, endovascular intervention may be considered.
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Affiliation(s)
- Qiu-Chi Li
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, China
| | - Ming-Hui Gong
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, China
| | - Zheng-Dong Wan
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, China.
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Kameda Y, Osawa H, Sueishi Y, Ishikawa Y, Maehara T. A case of delayed bleeding of the chest wall after VATS treated with transcatheter arterial embolization. J Surg Case Rep 2024; 2024:rjae271. [PMID: 38742017 PMCID: PMC11090606 DOI: 10.1093/jscr/rjae271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
We report a case of delayed bleeding after video-assisted thoracic surgery (VATS) that was successfully treated with transcatheter arterial embolization. An 81-year-old woman underwent a pleural biopsy via VATS for pleural dissemination of lung cancer. The postoperative course was good, but 8 days later she was hospitalized for swelling in the right axilla and was admitted to our hospital with a diagnosis of delayed postoperative hemorrhage. Gauze compression was performed, and the patient was discharged without exacerbation of hematoma. However, 4 days later, she was hospitalized for rapidly worsening swelling and pain. Chest computed tomography at the time of rebleeding showed an increase in the hematoma and extravasation in the peripheral right lateral thoracic artery. The patient was immediately treated with emergency angiography, and coil embolization was performed. After this treatment, the patient has done well and there has been no subsequent recurrence of bleeding.
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Affiliation(s)
- Yohei Kameda
- Department of Thoracic Surgery, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Kanagawa, Japan
| | - Hiroyuki Osawa
- Department of Thoracic Surgery, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Kanagawa, Japan
| | - Yui Sueishi
- Department of General Thoracic Surgery, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Yoshihiro Ishikawa
- Department of General Thoracic Surgery, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Takamitsu Maehara
- Department of Thoracic Surgery, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Kanagawa, Japan
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Park JY, Kang EJ, Park J. Spontaneous Rupture of the Internal Thoracic Artery Causing a Mediastinal Hematoma in a Patient with Alcoholic Liver Cirrhosis: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:750-756. [PMID: 37324984 PMCID: PMC10265232 DOI: 10.3348/jksr.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/01/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
Spontaneous arterial bleeding is uncommon, and a mediastinal hematoma caused by spontaneous rupture of the internal thoracic artery has not been reported previously. Patients with liver cirrhosis or heavy alcohol consumption have a higher risk of hemorrhage than those without cirrhosis or excessive alcohol consumption. We present the case of a 39-year-old female with a history of alcoholic liver cirrhosis, who presented with a large mediastinal hematoma attributable to spontaneous rupture of the internal thoracic artery.
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EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol 2022; 76:1151-1184. [PMID: 35300861 DOI: 10.1016/j.jhep.2021.09.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
The prevention and management of bleeding and thrombosis in patients with cirrhosis poses several difficult clinical questions. These Clinical Practice Guidelines have been developed to provide practical guidance on debated topics, including current views on haemostasis in liver disease, controversy regarding the need to correct thrombocytopenia and abnormalities in the coagulation system in patients undergoing invasive procedures, and the need for thromboprophylaxis in hospitalised patients with haemostatic abnormalities. Multiple recommendations in this document are based on interventions that the panel feels are not useful, even though widely applied in clinical practice.
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Pontell M, Scantling D, Babcock J, Trebelev A, Nunez A. Lateral Thoracic Artery Pseudoaneurysm as a Result of Penetrating Chest Trauma. J Radiol Case Rep 2017; 11:14-19. [PMID: 28580065 DOI: 10.3941/jrcr.v11i1.3015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pseudoaneurysms are potentially fatal complications of vascular trauma; however, they are rarely seen as the sole complication of penetrating injury. We present a case of a pseudoaneurysm with an associated arteriovenous fistula of the left lateral thoracic artery as a result of direct trauma from a knife stab. The patient presented only with a painful, swollen left pectoralis muscle. Upon diagnosis, he was taken to the interventional radiology suite and treated successfully with fluoroscopic guided coil embolization. Cases such as these are infrequent and should encourage more aggressive use of contrast enhanced computed tomography imaging for soft tissue injury, as a missed traumatic pseudoaneurysm may result in life-threatening hemorrhage.
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Affiliation(s)
- Matthew Pontell
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Dane Scantling
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jessica Babcock
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Alexander Trebelev
- Department of Vascular and Interventional Radiology, Hahnemann University Hospital, Philadelphia, PA, USA
| | - Alberto Nunez
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Trauma, Hahnemann University Hospital, Philadelphia, PA, USA
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Hong JS, Jeong WJ, Han YH, Shin SY, Jun JH, Woo YM, Yun JH, Cheon GJ. [A case of spontaneous bleeding of multiple lumbar arteries in a patient with liver cirrhosis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:186-9. [PMID: 25797384 DOI: 10.4166/kjg.2015.65.3.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Esophageal and gastric varix, portal hypertensive gastropathy, Mallory-Weiss tear and gastric ulcer are common causes of bleeding in patients with liver cirrhosis. However, spontaneous arterial bleeding without a history of trauma is a rare cause of bleeding which can be fatal. We report a case of a 55-year-old woman with alcoholic liver cirrhosis who developed spontaneous bleeding of multiple right lumbar arteries and died in spite of repetitive transfusion and embolization.
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Affiliation(s)
- Jong Sam Hong
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Woo Jin Jeong
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Yang Hee Han
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Sa Young Shin
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Jae Hyuck Jun
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Yeong Min Woo
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Jung Ho Yun
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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Mangla A, Hamad H, Yadav U, Telfer M. Alcohol abuse and alcoholic liver cirrhosis leading to spontaneous muscle hematoma: an event fraught with danger. Case Rep Gastroenterol 2015; 9:93-100. [PMID: 25969676 PMCID: PMC4427135 DOI: 10.1159/000381305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alcohol abuse is associated with both potentiating and antagonizing hemostatic states. Liver cirrhosis is an independent causal factor for many bleeding complications. The long-term effects of alcohol abuse coupled with advanced liver cirrhosis are additive in favor of bleeding. We report the case of a patient with a history of alcohol abuse who presented with liver cirrhosis and nontraumatic muscle hematoma diagnosed as a spontaneous hematoma of the gastrocnemius muscle. He was managed conservatively with infusions of fresh frozen plasma and platelets, which resulted in resolution of the hematoma. The pathogenesis of 'spontaneous' muscle hematoma remains anecdotal, but since it is reported in patients on anticoagulant therapy or with hemostatic disorders, it is hypothetically related to severely deranged coagulation. Here we review the relevant literature pertaining to the pathogenesis, presentation and treatment options available for treating this often fatal complication of bleeding diatheses.
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Affiliation(s)
- Ankit Mangla
- Department of Internal Medicine, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Ill., USA
| | - Hussein Hamad
- Department of Internal Medicine, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Ill., USA
| | - Udit Yadav
- Department of Internal Medicine, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Ill., USA
| | - Margaret Telfer
- Division of Hematology and Oncology, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Ill., USA
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Loukas M, du Plessis M, Owens DG, Kinsella CR, Litchfield CR, Nacar A, Lu O, Tubbs RS. The lateral thoracic artery revisited. Surg Radiol Anat 2013; 36:543-9. [PMID: 24281130 DOI: 10.1007/s00276-013-1234-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although the variations in the origin of the branches of the axillary and subclavian arteries have been well documented, little information regarding the highly variable lateral thoracic artery (LTA) is available. Descriptions of the LTA variations may prove useful during procedures of the lateral aspects of the thorax such as reconstructive plastic surgery and modified radical mastectomy. PURPOSE The aim of this study was to examine the anatomy of the LTA and offer an accurate account of its variability. METHODS The entire course and distribution of the LTA was examined in 420 formalin-fixed adult human cadavers. RESULTS The LTA was found in 96.7 % of the specimens, showing great morphological variability and classified into six types according to its origin. The most common type was where the LTA arose from the thoracoacromial artery (Type I 67.62 %). In decreasing order of incidence were origins from: the axillary artery (Type II 17.02 %), the thoracodorsal artery (Type III 5 %), and the subscapular artery (Type IV 3.93 %). Additionally, multiple LTAs were present (Type V 3.09 %) and complete absence of LTA (Type VI 3.33 %) was observed. CONCLUSION Despite variations in origin of the vessels, our dissections demonstrated that the ultimate tissue distribution of the LTA remained typical in the vast majority of the specimens and descended on the lateral border of the pectoralis minor. Our results illustrate the need for re-evaluation of the branches of the thoracoacromial artery with possible consideration that the LTA arises from it, instead of directly from the axillary artery. We hope that the information supplied by this study will provide useful information to anatomists and surgeons alike.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George University, St. George, Grenada, West Indies,
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Orchard P, Tan BH, Abayasekara K. Rupture of the profunda femoris artery in a patient with alcoholic liver disease: a case report. J Med Case Rep 2013; 7:95. [PMID: 23561730 PMCID: PMC3637401 DOI: 10.1186/1752-1947-7-95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/05/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Profunda femoris artery aneurysms are rare and often present with rupture. However, to the best of our knowledge, rupture of a non-aneurismal profunda femoris artery has never been reported before. Case presentation We report the case of a 31-year-old Caucasian man with alcoholic liver disease who presented with rupture of the profunda femoris artery following blunt trauma which was treated by endovascular embolization. Conclusion Coagulopathy secondary to alcoholic liver disease is a major contributory factor and a high index of suspicion of vascular injury must be attached to such patients following blunt trauma. Although there have no previous documented cases, treatment by endovascular embolization appears to be effective and safe.
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Affiliation(s)
- Philippa Orchard
- Department of Vascular Surgery, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
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