Traumatic false aneurysm of an intercostal artery

Clinical History

A 34-year-old male patient was admitted to the ER with left posterior thoracic penetrating trauma (stabbing); the patient was haemodynamically stable.

Imaging Findings

After admission, a chest radiograph was performed (Fig. 1) and showed an opacity of the middle and lower third of the left lung. Thorax CT was performed (Fig. 2) and showed a left posterior subcostal fluid collection, adjacent to the site of injury, showing progressive contrast enhancement, compatible with a false intercostal artery aneurysm.

Thoracic surgery was performed, with aneurysmectomy, and the patient was discharged without further complications.

Discussion

False aneurysm is a rupture of the arterial wall with subsequent haematoma formation bounded by neighbouring tissues. Its causes are varied, highlighting surgery, catheterization or trauma [1].
Chest pain is present in most cases. The initial assessment takes place with a chest radiograph, usually followed by CT [2].
CT angiography is the gold standard technique for diagnostic purposes; subcostal fluid collection, showing progressive contrast enhancement, is the most frequent and characteristic finding [2, 3].
Treatment is usually surgical although occasionally endovascular embolisation may be considered [3].
TEACHING POINTS: The intercostal pseudoaneurysm is a potentially fatal cause of haemothorax and is extremely rare. Imaging, particularly with CT, is of great importance to characterise and define size and extension of the lesion to nearby structures and evaluate the best therapeutic approach either surgical or endovascular.

Differential Diagnosis List

Final Diagnosis

Traumatic false aneurysm of an intercostal artery

URL:	https://www.eurorad.org/case/10197
DOI:	10.1594/EURORAD/CASE.10197
ISSN:	1563-4086