Aneurysm of the Internal Mammary Artery with Cystic Medial Degeneration

Okura, Yuji; Kawasaki, Takashi; Hiura, Takeshi; Seki, Hiroshi; Saito, Hirofumi

doi:10.2169/internalmedicine.51.8139

Cited by 17 publications

(28 citation statements)

References 12 publications

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“…Patients with non-ruptured aneurysms and relatively low tissue fragility, who have undergone surgery and interventional treatment, have been previously reported in the literature (10,11). Due to the small study size, more effective treatment for patients with arterial aneurysms have not yet been determined (12).…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of a ruptured left internal mammary artery aneurysm with a delayed diagnosis of type I neurofibromatosis

Kim

Jeong

et al. 2017

J. Thorac. Dis.

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Neurofibromatosis type I (NF-1) induced vasculopathy is rare but catastrophic complication after aneurysmal rupture. We present the case of a 55-year-old female who developed hypovolemic shock because of left internal mammary artery (IMA) pseudoaneurysm rupture associated with NF-1. Even she was not detected NF-1 at the time of arrival in emergency room. We decided to perform percutaneous embolization instead of surgical approach. In this case, after intervention, the ruptured left IMA aneurysm was well treated. After 10 days, the patient discharged without any complications. J Thorac Dis 2017;9(9):E739-E742 jtd.amegroups.com hematocrit (Hct), 32.2%. Three hours after the start of her examination, she reported dyspnea and chest pain that did not respond to analgesics; subsequently, she went into shock. Her blood pressure decreased to 60/40 mmHg; pulse, 98 beats/minute; respiratory rate, 20 breaths/minute; and oxygen saturation, 90% under a face mask with 10 L/min of oxygen. Hgb and Hct decreased to 5.6 g/dL and 16.7%, respectively. A computed tomography (CT) scan of the chest was performed, which showed active bleeding in the proximal left IMA and massive hemothorax accompanied by mediastinal shifting (Figure 1). Two units each of packed red blood cells and fresh frozen plasma were transfused; surgery and endovascular treatment were considered as treatment methods. We had previously surgically treated one patient with NF-1, 10 years ago, but the patient died. Since that case, we developed strategies for patients with NF-1, including performing interventional treatment, if possible.Taking into account the patient's unstable state and our surgical history with NF-1 patients, percutaneous embolization was chosen. The patient was transferred to the intervention room for the procedure. After approaching via the right common femoral artery, an angiogram was performed. Extravasation was observed at the site of a 1.1 cm × 1.0 cm pseudoaneurysm in the same location as the bleeding. We then performed a pre-ballooning procedure using interventional coiling. After superselective catheterization of the left IMA using a microcatheter and microwire, an embolization was performed using an Interlock coil (5 each). In a follow-up angiogram, no further extravasation was observed and no further treatment was required (Figure 2). The patient's clinical symptoms improved. She was transferred to the intensive care unit to be monitored for recurrent bleeding. A 24-Fr thoracic catheter was inserted and 1,300 mL of pleural fluid was drained, resulting in improvement of the dyspnea and hemothorax. The patient was transferred out of the intensive care unit 1 day after the treatment, and discharged 10 days after embolization, without any complications. Medication, consisting of acetaminophen 650 mg and tramadol Hcl 75 mg for pain control, was administered twice a day while she was hospitalized. There was no evidence of infection, therefore antibiotics were not used. Eighteen months later, the patient was healthy and had no finding...

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Section: Discussionmentioning

confidence: 99%

Successful treatment of a ruptured left internal mammary artery aneurysm with a delayed diagnosis of type I neurofibromatosis

Kim

Jeong

et al. 2017

J. Thorac. Dis.

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“…In fact, most of the treated cases were found incidentally during radiologic examinations shortly after previous negative examinations. 1,2,6 In addition, 37% of the cases were ruptured aneurysms: they caused massive hemothorax, and potentially led to death. 5,14 Even smaller aneurysm (e.g., 10e36 mm) did rupture.…”

Section: Discussionmentioning

confidence: 99%

“…1 True aneurysms of the ITA have been reported more rarely, especially in association with connective tissue diseases or vasculitis. 1e4 Traditionally, they have been treated with aneurysmectomy, while endovascular techniques have been successfully used but mainly in the form of coils embolization.…”

mentioning

confidence: 99%

Stent-graft Repair of a True Internal Thoracic Artery Aneurysm

Piffaretti

Carrafiello

Franchin

et al. 2015

Annals of Vascular Surgery

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“…A spontaneous development of an IMAA without a rememberable trauma or injury as described in our case is a rarity. Due to the low prevalence of IMAAs, informations regarding diagnosis and secure treatment options are scarce [ 1 ]. IMAAs typically appear with haemoptysis, cough and dyspnoea.…”

Section: Discussionmentioning

confidence: 99%

“…Aneurysms of the internal mammary artery (IMAA) are uncommon clinical entities [ 1 ] and usually occur in patients after sternotomy, placement of a central venous catheter or pacemaker leads [ 2 ]. Less common, these aneurysms are associated with vasculitis (e.g.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic internal mammary artery aneurysm

Heyn

Zimmermann

Klose³

et al. 2014

Journal of Surgical Case Reports

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Aneurysms of the internal mammary artery are extremely rare, and their presentation and treatment are variable. Since these aneurysms often tend to rupture and cause haemothorax and life-threatening conditions, the knowledge of secure treatment options is indispensable. We here report the case of an idiopathic internal mammary aneurysm in a 46-year-old man. Open surgical resection of the aneurysm was performed in this case without any complications. The postoperative course was uneventful and the patient was in a good physical condition without any vascular or neurological abnormalities during follow-up.

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Aneurysm of the Internal Mammary Artery with Cystic Medial Degeneration

Cited by 17 publications

References 12 publications

Successful treatment of a ruptured left internal mammary artery aneurysm with a delayed diagnosis of type I neurofibromatosis

Successful treatment of a ruptured left internal mammary artery aneurysm with a delayed diagnosis of type I neurofibromatosis

Stent-graft Repair of a True Internal Thoracic Artery Aneurysm

Idiopathic internal mammary artery aneurysm

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