# Spontaneous massive hemothorax due to inferior phrenic artery pseudoaneurysm: endovascular treatment approach

## TL;DR

A rare case of a ruptured inferior phrenic artery pseudoaneurysm causing hemothorax was successfully treated with endovascular embolization.

## Contribution

Presents a novel case of IPA pseudoaneurysm treated with glue:lipiodol embolization and highlights the role of imaging in diagnosis.

## Key findings

- Computed tomography angiography identified a left IPA pseudoaneurysm and massive hemothorax.
- Endovascular embolization with glue:lipiodol mixture resolved the pseudoaneurysm and hemothorax.
- The patient remained asymptomatic at 2-month follow-up, showing successful treatment outcomes.

## Abstract

Inferior phrenic artery (IPA) pseudoaneurysms are highly uncommon and result from trauma, pancreatitis, or iatrogenic injury. However, rupture can lead to catastrophic hemothorax. The vessel’s deep location and non-specific symptoms make early identification a difficult task. We report a case of a 22-year-old woman who was undergoing antitubercular therapy and presented with the onset of acute dyspnea after a five-month history of wheezing and hemoptysis. Computed tomography angiography revealed a pseudoaneurysm originating from the left IPA and a massive left hemothorax. This pseudoaneurysm sac and the descending branch of the IPA were successfully embolized with a glue: lipiodol mixture, followed by hemothorax evacuation. The patient is asymptomatic at 2-month follow-up. Endovascular embolization minimizes morbidity and enables rapid recovery when anatomy is favorable. This report emphasizes the importance of cross-sectional imaging in the early diagnosis and treatment planning of atypical hemothorax presentations.