Limits...
Hemomediastinum due to spontaneous rupture of a mediastinal bronchial artery aneurysm - A rare cause of thoracic pain.

Vosse BA, van Belle AF, de Vries GJ, Das M - Respir Med Case Rep (2014)

Bottom Line: Multiple underlying causes and contributory factors can be identified, such as trauma, malignancy, iatrogenic, bleeding disorder or mediastinal organ hemorrhage.Hemoptysis is an important directive symptom, however occasionally, patients only present with thoracic pain or symptoms related to extrinsic compression of the airways or esophagus.In this case report, a 76-year-old female is presented with spontaneous rupture of a mediastinal bronchial artery aneurysm resulting in hemomediastinum causing thoracic pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.

ABSTRACT
Hemomediastinum is a rare pathological event. Multiple underlying causes and contributory factors can be identified, such as trauma, malignancy, iatrogenic, bleeding disorder or mediastinal organ hemorrhage. Also, a mediastinal bronchial artery aneurysm may be the source of a hemomediastinum. Hemoptysis is an important directive symptom, however occasionally, patients only present with thoracic pain or symptoms related to extrinsic compression of the airways or esophagus. Using contrast-enhanced computed tomography (CT) of the chest, hemomediastinum can be adequately diagnosed, and the involved vascular structures can be revealed. In case of a (ruptured) bronchial artery aneurysm, transcatheter embolization provides a minimally invasive procedure and is treatment of first choice. In this case report, a 76-year-old female is presented with spontaneous rupture of a mediastinal bronchial artery aneurysm resulting in hemomediastinum causing thoracic pain. Superselective embolization of the left bronchial artery was successfully performed.

No MeSH data available.


Related in: MedlinePlus

Superselective coil embolization was performed with full occlusion of the feeding artery using fiber coils.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4061436&req=5

fig4: Superselective coil embolization was performed with full occlusion of the feeding artery using fiber coils.

Mentions: Two weeks later she attended the emergency room again with similar severe thoracic pain. She also mentioned complaints of heart burn and dysphagia. A contrast-enhanced chest CT was performed upon suspicion of a pulmonary embolism. The CT ruled out a pulmonary embolism, but did reveal a large mass in the posterior mediastinum (Fig. 1) with an axial diameter of 5.5 cm and cranio-caudal diameter of 7.4 cm, that extended to the subcarinal level (Fig. 2). This mass showed contrast extravasation suggesting active bleeding. Angiography was performed, demonstrating a large (pseudo)aneurysm of the left bronchial artery (Fig. 3). Superselective embolization using coils was successfully carried out (Fig. 4) in a coaxial way, using a 5F Cobra catheter and a microcatheter for superselective embolization. Fibered coils were placed distally and proximally to the pseudoaneurysm in order to avoid backflow and consecutive recurrence. The patient recovered quickly and was discharged two days after the procedure. Six weeks later, upon evaluation at the outpatient clinic, she was free of complaints and chest CT showed that the mediastinal hematoma had completely resolved (Fig. 5).


Hemomediastinum due to spontaneous rupture of a mediastinal bronchial artery aneurysm - A rare cause of thoracic pain.

Vosse BA, van Belle AF, de Vries GJ, Das M - Respir Med Case Rep (2014)

Superselective coil embolization was performed with full occlusion of the feeding artery using fiber coils.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061436&req=5

fig4: Superselective coil embolization was performed with full occlusion of the feeding artery using fiber coils.
Mentions: Two weeks later she attended the emergency room again with similar severe thoracic pain. She also mentioned complaints of heart burn and dysphagia. A contrast-enhanced chest CT was performed upon suspicion of a pulmonary embolism. The CT ruled out a pulmonary embolism, but did reveal a large mass in the posterior mediastinum (Fig. 1) with an axial diameter of 5.5 cm and cranio-caudal diameter of 7.4 cm, that extended to the subcarinal level (Fig. 2). This mass showed contrast extravasation suggesting active bleeding. Angiography was performed, demonstrating a large (pseudo)aneurysm of the left bronchial artery (Fig. 3). Superselective embolization using coils was successfully carried out (Fig. 4) in a coaxial way, using a 5F Cobra catheter and a microcatheter for superselective embolization. Fibered coils were placed distally and proximally to the pseudoaneurysm in order to avoid backflow and consecutive recurrence. The patient recovered quickly and was discharged two days after the procedure. Six weeks later, upon evaluation at the outpatient clinic, she was free of complaints and chest CT showed that the mediastinal hematoma had completely resolved (Fig. 5).

Bottom Line: Multiple underlying causes and contributory factors can be identified, such as trauma, malignancy, iatrogenic, bleeding disorder or mediastinal organ hemorrhage.Hemoptysis is an important directive symptom, however occasionally, patients only present with thoracic pain or symptoms related to extrinsic compression of the airways or esophagus.In this case report, a 76-year-old female is presented with spontaneous rupture of a mediastinal bronchial artery aneurysm resulting in hemomediastinum causing thoracic pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.

ABSTRACT
Hemomediastinum is a rare pathological event. Multiple underlying causes and contributory factors can be identified, such as trauma, malignancy, iatrogenic, bleeding disorder or mediastinal organ hemorrhage. Also, a mediastinal bronchial artery aneurysm may be the source of a hemomediastinum. Hemoptysis is an important directive symptom, however occasionally, patients only present with thoracic pain or symptoms related to extrinsic compression of the airways or esophagus. Using contrast-enhanced computed tomography (CT) of the chest, hemomediastinum can be adequately diagnosed, and the involved vascular structures can be revealed. In case of a (ruptured) bronchial artery aneurysm, transcatheter embolization provides a minimally invasive procedure and is treatment of first choice. In this case report, a 76-year-old female is presented with spontaneous rupture of a mediastinal bronchial artery aneurysm resulting in hemomediastinum causing thoracic pain. Superselective embolization of the left bronchial artery was successfully performed.

No MeSH data available.


Related in: MedlinePlus