A 48-Year-Old Man Presenting as an Emergency with Severe Back Pain, a Large Anterior Paravertebral Hematoma, and Spontaneous Rupture of the Right 9th Intercostal Artery Successfully Managed by Transcatheter Arterial Embolization: A Case Report

• Published in: The American journal of case reports 2022-02, Vol.23, p.e934173-e934173
• Main Authors: Izumoto, Shintaro, Abe, Tomohiro, Koroki, Takatoshi, Furukoji, Eiji, Masuda, Rie, Ochiai, Hidenobu
• Format: Article
• Language: English
• Subjects: Arteries; Back Pain; Embolization, Therapeutic; Hematoma - diagnostic imaging; Hematoma - etiology; Hematoma - therapy; Humans; Male; Middle Aged; Rupture, Spontaneous; Vascular Surgical Procedures
• ISSN: 1941-5923; 1941-5923
• DOI: 10.12659/AJCR.934173

BACKGROUND The rupture of an intercostal artery is rare and is usually associated with trauma, neurofibromatosis type 1, or coarctation of the aorta. Transcatheter arterial embolization is a minimally invasive vascular surgical procedure used to control hemorrhage of an intercostal artery. This report describes a case of a 48-year-old man who presented with severe back pain. This was due to a large anterior paravertebral hematoma following the spontaneous rupture of the right 9th intercostal artery. The rupture was successfully managed by transcatheter arterial embolization. CASE REPORT A 48-year-old man suddenly felt severe back pain while walking. He had no previous medical history and he had not experienced any external injury. On arrival, he was tachycardic and hypertensive. He did not have abnormal physical findings. His chest radiograph, 12-lead electrocardiogram, ultrasonography, and blood test findings were unremarkable. A chest computed tomography scan with contrast media was performed, which revealed a 4.3×2.7×7.0 cm mass, enhanced with contrast media, anterior to the 9th vertebral body. The patient was diagnosed with spontaneous rupture of the right ninth intercostal artery. The lesion was embolized with 8 microcoils. The patient was discharged on the 8th hospital day without complications. CONCLUSIONS This report presents a rare case of the rupture of an intercostal artery in which no cause was identified. It highlights the role of imaging as an important diagnostic tool. Furthermore, this report shows the benefits of the timely use of emergency transcatheter arterial embolization, which in this instance resulted in a successful outcome.