Successful embolization of a ruptured intercostal artery after violent coughing

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Introduction

Coughing is a complex physiological response that serves to protect airways from unwanted secretions and foreign materials. Paroxysmal and violent coughing is associated with many complications. In this article, we describe a patient who suddenly sustained an intercostal artery rupture with active bleeding after violent coughing. Definite hemostasis was achieved using transcatheter arterial embolization (TAE). To our knowledge, this is the first report of intercostal artery rupture with a huge hematoma formation as a consequence of coughing.

Section snippets

Case report

A 76-year-old man developed severe nonproductive cough caused by a viral upper respiratory tract infection for 2 days. The patient had a medical history of hypertension, chronic hepatitis C, and hypothyroidism. A right lateral thoracoabdominal mass lesion that was suddenly enlarging developed within 1 hour after a bout of vigorous coughing. The patient came to the ED for further evaluation. On physical examination, a huge soft mass approximately 15 cm in diameter was measured between the ninth

Discussion

Numerous complications are associated with coughing. They include syncope, bradycardia, rupture of subconjunctival nasal and anal veins, pneumothorax, pneumomediastinum, incontinence, the rupture of muscles [1], the herniation of the lung through the intercostal space [2], and the fracture of ribs [3]. Ruptured intercostal arteries caused by violent coughing have never been reported.

A number of variant etiologies causing intercostal artery bleeding have been identified, including blunt [4] or

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