Percutaneous Coil Embolization of Traumatic Juxtacardiac Rt Inferior Pulmonary Vein Pseudoaneurysm

Published in Journal of Vascular and Interventional Radiology in May 2015

Ivan Kuang Hsin Huang, MBBS, MMed, FRCR
Mahendran Nadarajah, MBBS, FRCR
Li Tserng Teo, MBBS, FRCS
Dokev Basheer Ahmed Aneez Ahmed, MBBS, FRCS, FAMS
Uei Pua, MBBS, MMed, FRCR, FAMS
Department of Diagnostic Radiology (I.K.H.H., U.P.);
Trauma and Acute Care Surgery Service, Department of
General Surgery (L.T.T.); and Thoracic Surgery and Thoracic
Oncology Service, Department of General Surgery (D.B.A.A.A.)

Editor:

We report a case of an acute large juxtacardiac right inferior pulmonary vein pseudoaneurysm following blunt chest trauma that was successfully treated with
direct percutaneous coil embolization. Our institution does not require ethics approval for case reports such as this.

A 49-year-old man sustained blunt chest wall injury during a motor vehicle accident and presented with a flail chest. He was subsequently intubated at the emergency department because of an inability to maintain oxygen saturation despite supplementary oxygen. Contrast-enhanced computed tomography (CT) of the thorax revealed a 3.21-cm  2.6-cm wide-necked juxtacardiac right inferior pulmonary vein pseudoaneurysm (Fig 1), together with multiple rib and sternal fractures, extensive pulmonary contusion, right hemothorax, left hydropneumothorax, and hemopericardium. After multidisciplinary consultation among trauma and cardiothoracic surgeons and interventional radiologists, it was agreed that surgical repair in the acute setting posed a high risk as a result of the central location of the lesion, current unstable hemodynamic status, and likely extensive adhesions from a previous pleurodesis. The consensus was to attempt embolization to stabilize the patient’s condition for eventual surgical repair.

Direct percutaneous access followed by coil embolization
was chosen after considering available resources andexpertise limitations for various endovascular approaches. For pulmonary venous access, the needle trajectory was planned by correlating internal landmarks on cone-beam CT with the thoracic CT images; the pseudoaneurysm was midway between the bifurcation of the right main bronchus and T6 vertebral body and was defined as the target on the navigation software.

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