Ann Thorac Surg 2005;80:e20-e21
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Spontaneous Rupture of the Inferior Thyroid Artery Leading to Life-Threatening Mediastinal Hematoma
Serban Bageacu, MD
a
,
*
,
Jean-Michel Prades, MD, PhD
b
,
David Kaczmarek, MD
a
,
Jack Porcheron, MD, PhD
a
a Department of General, Digestive and Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
b Department of Otolaryngology, University Hospital of Saint-Etienne, Saint-Etienne, France
* Address correspondence to Dr Bageacu, Department of Digestive Surgery, University Hospital of Saint-Etienne, CHRU Saint-Etiennne, Saint-Etienne, 42055 France (Email: serban.bageacu{at}chu-st-etienne.fr).
A 44-year-old woman with a history of chronic asthma was seen by her family physician for acute onset of dorsal pain. She developed acute pain in the interscapular area a few hours after an episode of violent coughing.
At physical examination, vital signs were normal. Spontaneous respiration was noted to be shallow and the neck was found to be enlarged and edematous. The patient was started on oxygen by mask at x l/minute and transferred by ambulance to the nearest emergency room.
Upon arrival at the medical center, the patient's vital signs were a pulse of 125 beats per minute, blood pressure 105/60, and oxygen saturation 88%. In the Emergency Department the dyspnea worsened and endotracheal intubation was unsuccessfully attempted. A surgical tracheotomy was performed. At tracheotomy, no obvious hematoma or active bleeding was found anterior to the trachea.
An emergent contrast-enhanced computed tomographic (CT) scan revealed a large hematoma in the neck and the posterior mediastinum, ruptured into the left pleural cavity (Fig 1: contrast-enhanced CT scan showing posterior mediastinal hematoma; Fig 2: contrast-enhanced CT scan showing left pleural effusion). After rapid hemodynamic resuscitation and blood transfusion, the patient was transferred to a level one trauma center for further investigation and specialized treatment.
After admission she was taken immediately to the angiographic room in an attempt to determine the source of active bleeding. Angiography showed a massive blush arising from the right inferior thyroid artery (Fig 3: aortic angiography showing rupture of the right inferior thyroid artery; Fig 4: subclavian angiography revealing rupture of the right inferior thyroid artery).
Selective angiography for transcatheter embolization was unsuccessful and the patient underwent surgical exploration. At surgery, the inferior thyroid inferior artery was ligated and the left pleural cavity was drained. After surgery, the patient recovered well, without any significant incident.
