SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Rupture of Bronchial Artery Pseudoaneurysm Exacerbated by Anticoagulant Therapy

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This case describes an 80-year-old woman taking apixaban for a prior pulmonary embolism who presented with severe interscapular back pain radiating to the epigastrium. She had no trauma history and significant cardiovascular comorbidities.<br /><br />CT angiography of the chest revealed a bronchial artery pseudoaneurysm with hemomediastinum, suggesting spontaneous rupture that was worsened by anticoagulation. Her apixaban was urgently reversed with prothrombin complex concentrate. Initial thoracic aortography and selective bronchial angiography could not identify the bleeding source, so therapeutic bronchial artery embolization failed. As her condition worsened and she became hemodynamically unstable, she required open thoracotomy. Mediastinal packing and topical hemostasis controlled the hemorrhage, and she was discharged after stabilization on hospital day 10.<br /><br />Two days later, she returned with right flank pain and shortness of breath. Repeat CT showed a more prominent bronchial artery pseudoaneurysm. This time, thoracic aortography and selective bronchial angiography identified a hypertrophied bronchial artery with active mediastinal extravasation. A second embolization attempt was successful, stopping the bleeding completely. She was discharged without recurrence.<br /><br />The discussion emphasizes that bronchial artery pseudoaneurysm is rare and often asymptomatic, but rupture can be fatal, especially in patients receiving anticoagulants. Possible causes include trauma, arteriovenous malformations, and inflammatory or infectious lung disease, though none were present in this patient. CT angiography is key for diagnosis, followed by aortography and selective bronchial angiography for localization. When feasible, transcatheter bronchial artery embolization is preferred over surgery, but thoracotomy may be necessary if embolization fails or the patient becomes unstable.<br /><br />This case highlights the importance of early recognition and rapid intervention in ruptured bronchial artery pseudoaneurysm, particularly in anticoagulated patients.

Asset Subtitle

Sana A. Pirzada

Meta Tag

Author List Meena Murugappan, Sana A. Pirzada, Shanzay A. Pirzada

Category Clinical Vignettes

Concept Bronchial Artery Pseudoaneurysm

Concept Mediastinal Hemorrhage

Concept Transcatheter arterial embolization

Concept Anticoagulant Reversal

Concept Anticoagulation Therapy

Distinguished Non-Finalist

Presenter Organization St. Luke’s Hospital, Chesterfield, MO, USA

Presenting Author Sana A. Pirzada

Track Adult

Keywords

bronchial artery pseudoaneurysm

hemomediastinum

apixaban

anticoagulation

pulmonary embolism

CT angiography

bronchial artery embolization

thoracotomy

mediastinal hemorrhage

selective bronchial angiography

Bronchial Artery Pseudoaneurysm

Mediastinal Hemorrhage

Transcatheter arterial embolization

Anticoagulant Reversal

Anticoagulation Therapy