Intercostal artery embolization in management of recurrent extrathoracic hematoma ; a case report

Abstract

A 62-year-old male was admitted to our hospital on July 30, 1990, with cough, sputum, fever, backache and an extrathoracic tumor. He had had a right lower lobectomy and partial resection of the diaphragm in 1988 for chronic expanding hematoma caused by fracture of the right 7th and 8th ribs in 1963. The diagnosis of extrathoracic hematoma was based on chest X-rays, chest CT scan, intercostal arteriography and thoracentesis. A metal wire for rib fixation protruded into the hematoma. The hematoma was resected and three wires removed on Aug. 13, but the extrathoracic hematoma recurred suddenly on Sep. 29. Intercostal arteriography was repeated on Oct. 5, and embolization of the intercostal artery was performed to prevent extravasation into the hematoma. After this procedure, the extrathoracic hematoma was absorbed gradually. He is doing well 3 years after the intercostal embolization.
The transcatherter bronchial artery occlusion technique is now well accepted in the management of massive and repeated hemoptysis. However, intercostal artery embolization has not been reported. We think that intercostal artery embolization is a very promising therapeutic approach for extrathoracic hematoma.