Correct!
1. Catheter aortography / intercostal angiography shows active contrast extravasation from an injured intercostal artery
The catheter aortography / intercostal arteriogram shows a progressive accumulation of amorphous contrast material as the imaging progresses from the early injection phase into the delayed phase, characteristic of contrast extravasation / active bleeding (Figure 7).
Figure 7. Left: Catheter aortography (A and B) with selective intercostal arteriography (C-D) shows a normal contour and caliber of the thoracic aorta; no evidence o of injury or pseudoaneurysm is present. The intercostal arteries (arrow head, B) are faintly visible on this aortic (i.e. non-selective) injection. With selection of the intercostal arteries, intercostal arterial opacification is improved (arrowheads, F-H). Images C-H reflect progression of the injection from earlier to delayed phases. As the imaging progresses, an amorphous contrast collection (curved arrows) develops and grows more pronounced as the intercostal arterial opacification fades, father into the delayed phase of the injection; the appearance is typical of active contrast extravasation due to active bleeding. No intercostal arterial pseudoaneurysm or bronchial arterial hypertrophy is present (the latter were not selectively injected). Right: Video of angiography.
The aorta appears normal as do the great vessels. The bronchial arteries are not well demonstrated on this examination as they are difficult to visualize with a non-selective aortic injection and they were not selectively cannulated for this study. No discrete, localized dilations of the intercostal arteries- or pseudoaneurysms- are evident.
The patient was treated with fluid resuscitation, vasopressor support, intubation with mechanical ventilation, and subsequently underwent video-assisted thoracoscopic surgery, which disclosed a large left hemothorax. The hemothorax was evacuated with placement of several large-bore thoracostomy tubes. Visual inspection of the aorta showed no evidence of injury. The left-sided rib fractures created a flail segment, and plate fixation and stabilization of the injured chest wall segment was being considered if the patient failed to wean from mechanical ventilation.
Diagnosis: Hemothorax with active bleeding, due to rib fractures
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