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Case report of emergent embolization for ruptured internal thoracic artery pseudoaneurysm in a 42-year-old femaleA rare artery rupture in a healthy woman was stopped with a catheter procedure

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Key Takeaway
Recognize ruptured internal thoracic artery aneurysm masquerading as pleural effusion in emergency settings.

This publication is a case report detailing the management of a ruptured internal thoracic artery pseudoaneurysm in a 42-year-old previously healthy female. The patient presented with hemothorax and underwent emergent transcatheter arterial embolization using microcoils alongside ultrasound-guided chest tube drainage. No medications were administered as part of the intervention described in this single-case narrative.

The primary outcome of achieving definitive hemostasis was successfully realized. The patient recovered uneventfully and was discharged without complications. No adverse events, serious adverse events, or discontinuations were reported during the follow-up period. Specific p-values or confidence intervals were not reported as this is a case report rather than a comparative trial.

The authors highlight a critical diagnostic pitfall in emergency medicine where a ruptured internal thoracic artery aneurysm can masquerade as a simple pleural effusion. The case underscores the pivotal role of computed tomography angiography and endovascular therapy in optimizing outcomes for this rare condition. Given the sample size of one, broader conclusions regarding efficacy or safety cannot be drawn from this evidence alone.

A healthy 42-year-old woman walked into the emergency department with a serious chest problem. Her internal thoracic artery had developed a weak spot and burst. This type of artery runs along the chest wall and supplies blood to the breast and chest muscles. When it ruptures, it can cause severe bleeding into the chest cavity. This condition is rare but dangerous because it can look like a simple fluid buildup. Doctors often miss it at first glance.

The medical team acted quickly to save her life. They performed an emergent transcatheter arterial embolization. This procedure uses tiny coils to plug the leaky artery and stop the bleeding. They also placed a chest tube under ultrasound guidance to drain the fluid. These steps achieved definitive hemostasis, which means they completely stopped the bleeding.

The patient recovered uneventfully and was discharged without complications. No adverse events or serious side effects were reported during her stay. This case report highlights a critical diagnostic pitfall in emergency medicine. It shows how a ruptured internal thoracy artery aneurysm can masquerade as a simple pleural effusion. The story underscores the pivotal role of computed tomography angiography and endovascular therapy in optimizing outcomes for these rare but critical conditions.

What this means for you:
A catheter procedure successfully stopped bleeding from a rare artery rupture in a healthy woman.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Internal thoracic artery (ITA) aneurysms are exceedingly rare vascular anomalies that often remain asymptomatic until rupture. Rupture can precipitate acute hemothorax, hemorrhagic shock, and death if not rapidly diagnosed and managed. We report the case of a 42-year-old previously healthy female who presented to the emergency department with sudden-onset chest, abdominal, and back pain. Initial CT imaging elsewhere revealed pleural effusion, a non-specific finding. Upon transfer to our institution, emergency computed tomography angiography (CTA) demonstrated a ruptured left ITA pseudoaneurysm with active contrast extravasation and a large left hemothorax. Emergent transcatheter arterial embolization using microcoils achieved definitive hemostasis. Ultrasound-guided chest tube drainage was subsequently performed. The patient recovered uneventfully and was discharged without complications. This case highlights a critical diagnostic pitfall in emergency medicine—ruptured ITA aneurysm masquerading as simple pleural effusion—and underscores the pivotal role of CTA and endovascular therapy in optimizing outcomes. We also review the literature on etiology, diagnostic challenges, and evolving therapeutic strategies for this rare but fatal condition.
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