Usefulness of transcatheter arterial embolization for intercostal arterial bleeding in a patient with burst fractures of the thoracic vertebrae.
A 25-year-old man was injured in a motorcycle accident and hemodynamically unstable on admission. Right hemothorax and fractures of the ninth, tenth, and 11th thoracic vertebrae were confirmed in chest X-ray. Tube thoracostomy in the right chest was performed and about 400 mL of blood was drained. Contrast-enhanced CT showed a large hematoma around the vertebrae fractures and contrast extravasation from the intercostal arteries. As hemodynamics of the patient was very unstable, angiography was immediately performed with massive fluid resuscitation. Angiography showed contrast extravasation from the bilateral ninth, tenth, and 11th intercostal arteries. Transcatheter arterial embolization (TAE) was performed using Gelfoam particles. The contrast extravasation had disappeared in all arteries. The hemodynamics of the patient gradually stabilized after TAE. On hospital day 44, he was transferred to a hospital near his home for an operation on the thoracic vertebrae and rehabilitation. When the reliability, rapidity, and low invasiveness of TAE for arterial bleeding are taken into consideration, we believed that this patient's life could be saved by TAE.
Hagiwara
Akiyoshi
A
Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama 359-8513, Japan. boeihagi@ndmc.ac.jp
Iwamoto
Shinichiro
S
D000063:Accidents, Traffic; D000792:Angiography; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D003287:Contrast Media