Presentation
Slowly reducing soft swelling on the right posterolateral side of the chest one month following bacterial pneumonia and drainage of a large right pleural effusion.
Patient Data
This is a camera-captured image showing the back of the chest. The right side is showing swelling with an outline in black. The central green dot represents the point through which a large-bore 16-gauge cannula was inserted for a diagnostic and therapeutic pleural tap.
Longitudinal grayscale ultrasound of the area of the swelling revealed hypoechoic area with surrounding edematous changes suggesting inflammatory process.
Color Doppler imaging of the area revealed yin-yang vascularity and the best possible diagnosis of the posterior intercostal artery aneurysm was made.
This is a rare case of iatrogenic posterior intercostal artery pseudoaneurysm.
Non-image guided attempts to drain parapneumonic pleural effusion with large bore cannula had resulted in injury to the posterior intercostal artery.
Case Discussion
Posterior intercostal artery pseudoaneurysms are rare and demonstrate yin-yang vascularity on color Doppler imaging.
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