Intercostal Artery Aneurysmosis

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Intercostal Artery Aneurysmosis John Alfred Carr, MD, Venu Vadlamudi, MD, Qazi S. Azher, MD The Annals of Thoracic Surgery Volume 96, Issue 5, Pages 1870-1873 (November 2013) DOI: 10.1016/j.athoracsur.2013.02.055 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Contrast-enhanced computed tomographic scan of chest demonstrates large ruptured intercostal artery aneurysm in patient’s right thorax, with mass effect on left atrium and esophagus. Nasogastric tube can be seen in esophagus anterior to aorta. (B) Additional intercostal artery aneurysm arising from tortuous left intercostal artery at same level of ruptured right intercostal aneurysm is noted. (C) Intraoperative photograph of the ruptured right intercostal artery aneurysm. (D) Ex vivo photograph of 6-cm ruptured right intercostal artery aneurysm (left). Note clot adherent to site of rupture on left side of aneurysm. Smaller 4-cm unruptured right intercostal artery aneurysm was also excised (right). The Annals of Thoracic Surgery 2013 96, 1870-1873DOI: (10.1016/j.athoracsur.2013.02.055) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Selective left T7 intercostal arteriogram demonstrating large proximal intercostal artery aneurysm and tortuous intercostal artery. (B) Coil embolization of another left intercostal artery aneurysm. Three of 4 left intercostal artery aneurysms were successfully embolized. (C) Computed tomographic scan 6 months later showing enlargement of fourth left intercostal artery aneurysm from 3.7 to 5.1 cm, with a larger contrast swirl within lumen. (D) Angiogram of same aneurysm shown in C, which could not be embolized. The Annals of Thoracic Surgery 2013 96, 1870-1873DOI: (10.1016/j.athoracsur.2013.02.055) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Ex vivo photograph of aneurysm shown in Fig 2C and 2D. (B) Opened aneurysm. (C, D) Photomicrographs of aneurysm wall. (C) Hematoxylin and eosin (original magnification, 40×). (D) Hematoxylin and eosin (original magnification, 100×). The Annals of Thoracic Surgery 2013 96, 1870-1873DOI: (10.1016/j.athoracsur.2013.02.055) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions