First case of cough-induced combined intercostal artery rupture with partial diaphragm tear
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CASE REPORT
First case of cough-induced combined intercostal artery rupture with partial diaphragm tear Niravkumar K Sangani 1
&
Santosh Mathew Naliath 1
Received: 21 April 2020 / Revised: 14 June 2020 / Accepted: 29 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract We describe a case of vigorous cough-induced left intercostal artery rupture with partial diaphragmatic tear in a 60-year-old obese male with chronic obstructive pulmonary disease. He presented with left hemothorax, a rapidly spreading chest and abdominal wall hematoma, and progression of anemia. Computed tomography (CT) scan revealed a bleeding focus from the left 8th intercostal artery. CT-guided surface marking of the bleeding point was done over the chest wall. The patient underwent open thoracotomy with drainage of clotted hemothorax and ligation of bleeding intercostal artery. Incidentally, a partial diaphragm tear was detected during the surgery which was repaired. The combined presentation of cough-induced intercostal artery rupture with partial diaphragm tear is not reported earlier. Awareness of these co-existing pathologies can facilitate timely diagnosis and appropriate life-saving management. Keywords Intercostal artery rupture . Hemothorax . Hematoma . Cough . COPD . Diaphragm
Introduction Intercostal artery rupture (IAR) is a rare and potentially lifethreatening condition [1]. Severe cough is a common accompaniment with acute exacerbations of chronic obstructive pulmonary disease (COPD). We describe a unique presentation in a 60year-old male with COPD who had vigorous tussive efforts leading to left 8th IAR with a partial diaphragmatic tear. It resulted in a left hemothorax, a rapidly spreading chest and abdominal wall hematoma, and progression of anemia, which was successfully treated surgically with open thoracotomy.
Case report A 60-year-old diabetic, obese (BMI, 30.2 kg/m2) male with a history of smoking (20 pack years) and COPD (10 years) was admitted to a local hospital with sudden onset severe pain in the left lower chest and abdomen associated with shortness of breath. It started after bouts of severe coughing lasting several * Niravkumar K Sangani [email protected] 1
Department of Cardiothoracic Surgery, Ahalia Hospital, Abu Dhabi, United Arab Emirates
minutes. There was no history of trauma. It was associated with left hemothorax and hematoma over the left chest and abdominal wall. During the course of his admission at the local hospital over 4 days, his hematoma rapidly expanded to involve bilateral abdominal and pelvic walls. His hemoglobin dropped from 14.0 to 9.0 g/dl. He was urgently transferred to our hospital. On arrival, he was tachypneic (respiratory rate, 22/min) with decreased air entry in the left lower zone and bilateral diffuse rhonchi. His vital signs were pulse, 110/min; blood pressure, 100/60 mmHg; temperature, 37.8 °C; saturation, 95% on O2-4 l/min. Large tender areas of hematoma and ecchymosis were noted over the left lateral chest wall and bilateral abdominal and p
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