Massive hemothorax due to rupture of internal thoracic artery aneurysm after vaginal delivery

A 30 year-old woman presented at the casualty department 12 days after having given birth to a healthy baby via normal vaginal delivery. She complained of increasing pain and a mass in her right flank. There were no complaints of nausea, vomiting, dysuria or abnormal bowel habits. On examination, the patient was acutely distressed, in severe pain and was anaemic with an Hb of 5 g/dl. Her blood pressure was 151/71 mmHg and her pulse rate 125/minute. Physical examination revealed a severely distended abdomen with features of peritonitis. An abdominal ultrasound revealed a large abdominal fluid collection and a CT scan was therefore requested. A contrast-enhanced CT scan demonstrated a large homogenous retroperitoneal fluid collection in the right flank, with a 25mm rounded, intensely enhancing focus located close to the inferior border of the collection. The collection displaced the bowel to the left and inferiorly, and the liver, superiorly. The differential diagnosis included a ruptured ovarian artery aneurysm. As soon as the patient was stable, she was taken for ovarian artery embolization that was successfully accomplished. The patient recovered well in the ward.

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Endovascular Treatment of a Ruptured Internal Thoracic Artery Pseudoaneurysm Presenting as a Massive Hemothorax in a Patient with Type I Neurofibromatosis

CardioVascular and Interventional Radiology ◽

10.1007/s00270-004-0067-8 ◽

2005 ◽

Vol 28 (6) ◽

pp. 818-821 ◽

Cited By ~ 27

Author(s):

Soo Jin Kim ◽

Chang Won Kim ◽

Suk Kim ◽

Tae Hong Lee ◽

Kun Il Kim ◽

...

Keyword(s):

Endovascular Treatment ◽

Internal Thoracic Artery ◽

Type I ◽

Artery Pseudoaneurysm ◽

Massive Hemothorax

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Rupture of internal pudendal artery aneurysm following spontaneous vaginal delivery: An uncommon cause of post-partum bleeding

Obstetric Medicine ◽

10.1177/1753495x16647618 ◽

2016 ◽

Vol 9 (3) ◽

pp. 138-141 ◽

Cited By ~ 1

Author(s):

Daniel Martingano ◽

Francis X Martingano ◽

Rosemary Ruggiero-DeCarlo

Keyword(s):

Vaginal Delivery ◽

Post Partum ◽

Artery Aneurysm ◽

Normal Vaginal Delivery ◽

Arterial Aneurysm ◽

Internal Pudendal Artery ◽

Increased Risk ◽

Internal Iliac ◽

High Risk Situation ◽

The Right

Pregnancy-related rupture of an arterial aneurysm is an unusual occurrence associated with increased risk of morbidity and mortality. Various pregnancy-related physiologic changes appear to make pregnancy a high-risk situation for rupture of either preexisting arterial aneurysms or those that develop throughout the course of pregnancy. Splenic artery aneurysms are the most common (60%), followed by hepatic (20%), superior mesenteric (5.9%), celiac (4%), ovarian, uterine, and renal (<2%) artery. Even rarer are aneurysms involving the internal iliac artery and its branches, to which there is only one published case report. In this report, we present a case of a 34-year-old pregnant gravida1 para0 who, following a normal vaginal delivery, had a severe rupture of the right internal pudendal artery and subsequently developed a massive hematoma which ultimately required embolization treatment.

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