Correct!
4. Catheter aortography with intercostal artery selection and embolization
Active bleeding, as demonstrated on the contrast-enhanced thoracic CT, is an emergent situation requiring definitive therapy combined with supportive therapy (e.g., reversal of anticoagulant influences, fluid resuscitation, transfusion, etc.). In this context, definitive therapy could consist of immediate surgery for control of hemorrhage (this option was not offered in the choices above) or aortography with intercostal artery selection to identify the site of bleeding, followed by embolotherapy. Repeated thoracentesis may be a management option for chronic pleural effusions unassociated with hemodynamic compromise, such is chronic, recurrent malignant pleural effusions, but would not play a role here. Catheter pulmonary angiography and embolotherapy would not play a role here because the bleeding is not originating from the pulmonary arterial circulation; rather, the origin of the bleeding in the context of hemothorax is the intercostal arteries, and hence from the aorta. This patient’s bleeding is not originating from the airways or bronchial circulation, so endoscopic therapy with rigid bronchoscopy and stent placement would not be an appropriate choice.
Further clinical course: The patient underwent catheter aortography with selective intercostal arteriography (Figure 6).
Figure 6. Left: Catheter aortography (A and B) with selective intercostal arteriography (C-H). Right: video of angiography.
Which of the following is the most accurate description of this this patient’s aortography and intercostal arteriography findings? (Click on the correct answer to proceed to the eighth and final page)