Aneurysmal rupture of the costo-cervical trunk in a patient with neurofibromatosis type 1: A case report.
BACKGROUND
Rupture of blood vessels associated with neurofibromatosis type 1 (NF-1) is a rare but life threatening complication. We report the first case of an aneurysmal rupture from the costocervical trunk in a NF-1 patient treated by endovascular embolisation.


METHODS
A 43 year-old gentleman with a past medical history of NF-1 presented with sudden onset left sided neck swelling. A computed tomography (CT) revealed a large cervical haematoma, which was causing airway compromise, requiring the patient to be intubated. Percutaneous embolisation of the bleeding vessel from the costo-cervical trunk was performed with successful haemostasis and no immediate complications. A repeat CT scan showed a reduction in the original cervical haematoma. However, six days post embolisation, the patient arrested with complete whiteout of the left hemithorax.


CONCLUSIONS
CT angiography is the gold standard for diagnosis of an aneurysmal rupture in NF-1 patients, and percutaneous embolisation is the preferred modality in patients who are haemodynamically stable due to arterial fragility and high intra operative mortality rates. The increasing haemothorax could be explained by the original cervical haematoma draining down into the pleural space, or the possibility of a new second bleed.


CONCLUSIONS
This is the first reported episode of bleeding from the costocervical trunk in NF-1 patients. Ruptured aneurysms require urgent CT angiography, if haemodynamically stable, and further input from the vascular surgeons and vascular radiologists.
Department of Vascular Surgery, Colchester General Hospital, Colchester CO4 5JL, UK. Electronic address: pinderhoonjan@hotmail.com.
Bhupinder
B
Hoonjan
Department of Radiology, Colchester General Hospital, Colchester CO4 5JL, UK.
Nagendra
N
Thayur
Department of Vascular Surgery, Colchester General Hospital, Colchester CO4 5JL, UK.
Abdusalam
A
Abu-Own
Aneurysmal rupture; Angiogram; Costo-cervical trunk; Embolisation; Neurofibromatosis type 1; Von Recklinghausen disease