Conservative Management of Spontaneous Posterior Mediastinal Intercostal Artery Hemorrhage: A Case Report and Literature Review

IF 1.6 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2026-01-01 Epub Date: 2025-11-04 DOI:10.1016/j.jemermed.2025.11.001

Masahiko Okada MD , Hisashi Yanaihara MD , Mika Misaki MD , Nao Kohata MD, PhD , Yusuke Suzuki MD, PhD , Takanori Asakura MD, PhD

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引用次数: 0

Abstract

Background

Intercostal artery hemorrhage (ICAH) is an extremely rare, potentially life-threatening condition. The etiology of ICAH includes trauma, anticoagulation therapy, bleeding disorders, infections, and underlying diseases such as neurofibromatosis type 1, systemic lupus erythematosus, and hypertension. Due to the rarity of this condition, standardized treatment strategies remain undefined. We report a rare case of spontaneous ICAH successfully managed with conservative therapy and review relevant literature.

Case Report

A 49-year-old male presented with sudden and progressively worsening abdominal and back pain. He had no history of trauma or underlying diseases, except for previously undiagnosed and uncontrolled hypertension. Imaging revealed a hemorrhage from the intercostal artery in the posterior mediastinum, which was considered to be the likely source of bleeding. Given the patient’s hemodynamic stability and location of the hematoma, conservative management was selected. Blood pressure was initially controlled with intravenous nicardipine, followed by oral sacubitril/valsartan and nifedipine administration. The hematoma did not increase in size, and the patient was discharged on day 15, without complications. Follow-up imaging confirmed complete resolution of the hematoma, and the patient’s blood pressure remained stable without further antihypertensive medication use.

Why Should an Emergency Physician Be Aware of This?

Although ICAH is extremely rare, it can cause life-threatening bleeding. Prompt recognition is essential, especially when imaging reveals a posterior mediastinal hematoma without trauma or anticoagulation therapy. Conservative management may be feasible in hemodynamically stable patients with natural tamponade; however, careful patient selection and close monitoring are crucial. Awareness of this condition can help avoid unnecessary invasive procedures.

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自发性后纵隔肋间动脉出血的保守治疗：1例报告及文献复习。

背景：肋间动脉出血（ICAH）是一种极其罕见的潜在威胁生命的疾病。ICAH的病因包括创伤、抗凝治疗、出血性疾病、感染和基础疾病，如1型神经纤维瘤病、系统性红斑狼疮和高血压。由于这种情况的罕见性，标准化的治疗策略仍然不明确。我们报告一例罕见的自发性ICAH经保守治疗成功的病例，并回顾相关文献。病例报告：一名49岁男性表现为突然和逐渐恶化的腹部和背部疼痛。他没有外伤史或基础疾病，除了以前未确诊和未控制的高血压。影像显示后纵隔肋间动脉出血，认为可能是出血的来源。考虑到患者血流动力学的稳定性和血肿的位置，选择保守治疗。最初通过静脉注射尼卡地平控制血压，随后口服苏比里尔/缬沙坦和硝苯地平。血肿没有增大，患者于第15天出院，无并发症。随访影像证实血肿完全消退，患者血压保持稳定，无需进一步使用降压药。急诊医生为什么要意识到这一点？虽然ICAH极为罕见，但它会导致危及生命的出血。及时识别是必要的，特别是当影像学显示后纵隔血肿没有外伤或抗凝治疗。对于血流动力学稳定的自然填塞患者，保守治疗是可行的；然而，仔细选择病人和密切监测是至关重要的。意识到这种情况可以帮助避免不必要的侵入性手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine