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E1674. Rare Complication: Managing Massive Hemothorax After Thoracentesis
Authors
  1. Sayed Sadat; Hemet Valley Medical Center
  2. Drew McKinney; St. George's University
  3. Saad Farooq; Hemet Valley Medical Center
  4. Krishna Das; Hemet Valley Medical Center
  5. Rahul Nayyar; Victor Valley Global Medical Center
Background
Thoracentesis is a very common procedure performed for diagnostic or therapeutic purposes. A complication that occurs in approximately 1-2% of patients is iatrogenic intercostal artery bleed. This is a potential life threatening complication, which requires rapid identification and treatment. Multiphase CT chest can identify the iatrogenic post thoracentesis complication. Subsequent evaluation with US is needed to achieve arterial access. Insertion of guidewire and catether under fluoroscopy and Digital Substraction Angiography allows for precise localization of the bleeding vessel and follow-up embolization.

Educational Goals / Teaching Points
This paper will demonstrate a rare post-thoracentesis complication, iatrogenic intercostal artery bleed. We will discuss the typical imaging findings and subsequent image guided treatment to stop the arterial bleed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The patient in this case is a 61-year-old female with recent thoracentesis. Physical exam and imaging findings were consistent with iatrogenic intercostal arterial bleed, as demonstrated by high density material (contrast) extravasation in arterial and venous phase imaging. Under imaging guidance, the bleeding vessel was identified and embolized successfully.

Conclusion
Iatrogenic laceration of the intercostal arteries have been reported to occur in up to 1-2% of thoracocentesis, with the actual number of cases likely being higher due to underreporting of incidences. ICA and/or its collaterals have been demonstrated to course superior to the rib, making laceration more likely. Radiographic evaluation through X-ray, CT, Ultrasound, and Digital Subtraction Angiography are able to identify hemothorax secondary to iatrogenic intercostal artery bleed, help obtain arterial access, localize/embolize the bleeding vessel, and confirm proper hemostasis. Compared to the alternative, this route of treatment is less invasive and lacks the post-surgical complications.