A case of a hemothorax due to rupture of an intercostal arterial aneurysm in a patient with neurofibromatosis type 1
2019 Volume 33 Issue 2 Pages 200-205
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2019 Volume 33 Issue 2 Pages 200-205
A 45-year-old man was admitted to our hospital due to sudden left back pain. He had neurofibromatosis type 1 (NF1). Chest computed tomography (CT) showed left pleural effusion. A chest drainage tube was inserted, and bloody effusion was obtained. Because the bleeding source could not be identified by contrast-enhanced CT, we performed thoracoscopic surgery to identify the source, which was near the 11th costotransverse joint. Bleeding was stopped by direct pressure with a tissue-sealing sheet and fibrin glue.
Subsequent arteriography revealed aneurysms in the 11th intercostal artery, and transcatheter arterial embolization (TAE) was performed. His postoperative course was uneventful.
It is important to keep in mind that rupture of an intercostal arterial aneurysm might cause hemothorax in patients with NF1. Surgical interventions such as ligation, cauterization, and coagulation might be high-risk procedures because vascular walls in NF1 patients are fragile. Thoracoscopic surgery of temporal hemostasis and subsequent TAE could be a treatment of choice for such cases.
