A rare complication of thoracotomy: thoracodorsal artery pseudoaneurysm

Background

Pseudoaneurysms are pathological formations that can develop after trauma, inflammation, or surgery, with symptoms sometimes emerging following a latent period.

Case report

This paper examines a 66-year-old female patient with a history of thoracotomy for descending aortic aneurysm repair who presented to the emergency department with swelling and loco-regional pain in the left lateral chest wall. The patient was referred to the radiology unit with suspected abscess in the left chest wall. Ultrasonography (US) and color Doppler US (CDUS) revealed a thoracodorsal artery pseudoaneurysm in the area thought to be an abscess. This paper presents the radiological findings of this previously undocumented late complication of thoracotomy and emphasizes the importance of considering vascular complications in patients presenting with chest wall swelling.

Why should an emergency physician be aware of this?

Emergency physicians must recognize that post-thoracotomy chest wall swellings could be pseudoaneurysms rather than abscesses or hematomas. Careful physical examination detecting pulsation or bruit should prompt vascular imaging. Familiarity with characteristic ultrasonographic findings ("yin-yang" sign, "to-and-fro" flow pattern) facilitates accurate diagnosis. Mismanagement, such as incision of a misdiagnosed pseudoaneurysm, may cause catastrophic hemorrhage. Maintaining high suspicion in patients with thoracic surgical history ensures appropriate vascular surgery referral.