2023 Volume 37 Issue 4 Pages 198-204
A 32-year-old man was transferred to the emergency department with a complaint of sudden left chest pain. He had been diagnosed with neurofibromatosis type 1 at one year of age. Chest CT showed a left tension hemothorax, and he was in shock. Therefore, emergency surgery was performed to stop the bleeding, and arterial bleeding was observed near the left subclavian artery in the thoracic cavity. However, hemostasis was difficult to achieve because of the fragility of the vascular tissue. Percutaneous angiography was performed with gauze packing to control bleeding. It revealed extravasation of the contrast agent from the internal thoracic artery, and transcatheter arterial embolization (TAE) was performed. He recovered with a good course, but on the 12th hospital day, he suddenly developed a bulge and pain in his left neck. Emergency percutaneous angiography was performed to detect re-bleeding from the cervical artery. This indicated bleeding from the left vertebral and thyrocervical arteries. TAE was performed at the same site to prevent bleeding. Although vascular tissue fragility and arterial hemorrhage are rare in neurofibromatosis type 1, it is imperative to initiate treatment as soon as feasible.
