Spontaneous Subdiaphragmatic Hemorrhage From an Aneurysm of Inferior Phrenic Artery

TL;DR

This paper reports a rare case of a spontaneously ruptured aneurysm in the inferior phrenic artery, managed through embolization.

Contribution

The paper presents a rare clinical case of spontaneous IPA pseudoaneurysm with a unique anatomical extension and successful endovascular treatment.

Findings

IPA aneurysms are rare and often linked to trauma, surgery, or systemic diseases.

The case involved a pseudoaneurysm extending from the posterior mediastinum to the subdiaphragmatic area.

Endovascular embolization with coil and gel foam was effective in managing the rupture.

Abstract

Inferior phrenic artery (IPA) aneurysms are the rarest type of visceral aneurysms. It usually occurs secondary to trauma, surgery, or as a complication of pancreatitis. In addition, it can be a manifestation of underlying systemic pathology such as vasculitis, collagen vascular disorders, sepsis, or segmental arterial mediolysis. It can be associated with hypertension in 43% of cases. The presentation of IPA aneurysm is nonspecific with abdominal pain, melena, hematochezia, and anemia. The ruptured and actively bleeding aneurysm can lead to hemorrhagic shock, and immediate management is required with angiography and endovascular embolization with coil or gel foam or stent etc. Inaccessible locations are reached with surgical intervention, but it is associated with high morbidity and mortality. We here report a rare case of spontaneously ruptured IPA pseudoaneurysm extending from the posterior mediastinum to the subdiaphragmatic area and managed with coil and gel foam embolization.

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