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• W4387267788 abstract "SESSION TITLE: Vascular Complications in the ICU SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Hemorrhagic shock is one of the main causes of death in patients with trauma, as severe blood loss can result in cellular and tissue hypoxia. Although hemorrhage from penetrating injury is usually easily identified, hemorrhage from blunt injuries can be concealed and difficult to localize. Early recognition of the hemorrhagic shock as well as adequate resuscitation during the evaluation to definitively treat the bleeding vessel is necessary to improve outcomes. Here we present a case of hemorrhagic shock due to intercostal artery bleeding after blunt trauma to the flank. CASE PRESENTATION: A 64-year-old female patient was brought to the emergency department after she sustained a backward ground-level fall in her home, impaling her left flank to a cabinet handle. Upon initial evaluation, the cabinet handle was located only within the subcutaneous tissue and easily removed. She was admitted for observation. However, about 24 hours after the initial presentation, she became hypotensive with a blood pressure of 68/34. She was cold, clammy, and lethargic. She was transferred to the intensive care unit. Initial labs showed a drop in her hemoglobin with metabolic acidosis. Two units of blood were transfused. CT angiography of the chest, abdomen, and pelvis showed a large area of hemorrhage overlying the left flank with findings suggestive of active contrast extravasation. The interventional radiology team performed angiography, which showed active arterial bleeding from the 12th left intercostal artery, and it was embolized successfully. The patient's hemodynamic status improved, and she was discharged. DISCUSSION: Intercostal artery (ICA) bleeding is rare, yet it can be life-threatening. It has many etiologies, but trauma (both blunt and penetrating) remains the most common, besides iatrogenic injury in many elective and emergency thoracic procedures. Also, spontaneous ICA bleeding was described in patients with some diseases like systemic lupus erythematosus, neurofibromatosis type 1, or coarctation of the aorta. Clinically, ICA injuries may manifest with different presentations, including hemothorax which can develop up to 16 days after the initial injury, extra-pleural hematomas, and rarely abdominal wall hematomas. When patients present with rapidly expanding hematomas or hemodynamic instability, urgent intervention in addition to correction of any coagulopathy is necessary. Transcatheter arterial embolization (TAE) is a dependable and generally safe approach for managing ICA bleeding, with a success rate of nearly 80%. However, if the hemorrhage is massive or if embolization is not successful, surgical options should be considered. In our case, the patient was found to have ICA bleeding causing a large flank hematoma and hemorrhagic shock after flank trauma leaving a foreign body embedded in the superficial tissue. CONCLUSIONS: A high index of suspicion for concealed hemorrhage after blunt injuries in the appropriate clinical setting is necessary to improve outcomes. CT angiography may be a good initial study for confirming bleeding and localizing the bleeding vessel. REFERENCE #1: Matsumoto N, Hayashi N, Morita C, Taguchi Y, Chan M, Tagawa Y, Sakahira H, Takaoka M. A case of hemorrhagic shock due to intercostal artery injury that occurred during initial trauma care with multiple displaced rib fractures and traumatic head injury. Trauma Case Rep. 2022 May 25;40:100658. doi: 10.1016/j.tcr.2022.100658. PMID: 35665200; PMCID: PMC9157016. REFERENCE #2: Laeeq K, Cheung S, Phillips B. Hemoperitoneum secondary to intercostal arterial bleeding in a trauma patient. J Surg Case Rep. 2017 Jan 19;2017(1):rjw194. doi: 10.1093/jscr/rjw194. PMID: 28108633; PMCID: PMC5260848. REFERENCE #3: Shen, Ching-Yi, Chien-Han Hsiao, Weide Tsai, Ding-Kuo Chien, Wen-Han Chang, & Tse-Hao Chen. Lethal intercostal artery injury after a fall. Quantitative Imaging in Medicine and Surgery [Online], 12.3 (2022): 2203-2205. Web. 31 Mar. 2023 DISCLOSURES: No relevant relationships by Saif Abu-Baker No relevant relationships by Mohamad Al-Momani No relevant relationships by Omar Ammari No relevant relationships by Rami Dalbah No relevant relationships by Adel El Abbassi No relevant relationships by Ahmad Othman" @default.
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• W4387267788 date "2023-10-01" @default.
• W4387267788 modified "2023-10-03" @default.
• W4387267788 title "INTERCOSTAL ARTERY BLEEDING PRESENTING WITH HEMORRHAGIC SHOCK" @default.
• W4387267788 doi "https://doi.org/10.1016/j.chest.2023.07.1814" @default.
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