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Pleural haematoma secondary to spontaneous rupture of an intercostal artery aneurysm is extremely rare but can be life-threatening. Most documented cases have been associated with coarctation of the aorta or neurofibromatosis type 1,1 or occur following trauma2 or thoracic surgery.
A 73-year-old man on warfarin presented with right shoulder pain and breathlessness during air travel. He had no history of trauma, rib fractures or stigmata of neurofibromatosis. His INR was 2.7. His chest radiograph demonstrated a right pleural opacity later revealed to be an extrapleural haematoma (fig 1A). He became haemodynamically unstable following attempted pleural aspiration and required initial intubation and inotrope support. A contrast-enhanced CT scan revealed an isolated right fifth intercostal artery aneurysm (fig 1B). Angiography allowed therapeutic embolisation with Spongostan particles and right thoracotomy to evacuate the clot (fig 1C). This case illustrates well the potential life-threatening nature of these aneurysms1 and suggests that prompt intervention is merited whenever these lesions are detected.
Isolated intercostal artery aneurysms can occur rarely.
Spontaneous rupture of intercostal artery aneurysms can cause life-threatening haemorrhage.
Identification of an intercostal artery aneurysm should prompt therapeutic embolisation.
Competing interests: None.
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