CTICasesHemothorax due to Iatrogenic Intercostal Artery Injury during Biliary Drain Placement
Imaging findings
A patient with liver disease, following a percutaneous transhepatic biliary drain placement, developed acute respiratory distress and a new, essential white-out of the right hemithorax with significant mediastinal shift. Angiography confirmed active extravasation from a nicked intercostal artery at the site of the drainage tube insertion, which was subsequently embolized.
Key takeaways
Iatrogenic injury to an intercostal artery during percutaneous procedures (e.g., chest tube, biliary drain placement) can lead to rapid and severe hemothorax. Careful attention to technique and awareness of intercostal vessel anatomy (avoiding the inferior rib margin) are crucial. Angiography is effective for identifying the bleeding source and facilitating embolization.
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