Division of Neuroradiology, Department of Radiodiagnosis and Imaging, 29751Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Otolaryngology and Head and Neck Surgery, 29751Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Vasc Endovascular Surg. 2022 Feb;56(2):208-211. doi: 10.1177/15385744211051504. Epub 2021 Oct 8.
Tracheostomy-related arterial haemorrhage can be devastating especially if arising from an obscure anomalous vessel which can potentially complicate treatment decision.
We report a case of non-Hodgkin's lymphoma with upper airway obstruction, who had profuse bleeding, post-tracheostomy, from the stomal site. CT angiography showed presence of a pseudoaneurysm adjacent to the tracheostomy site which was confirmed on catheter angiography to be arising from anomalous thymic branch of right common carotid artery (CCA). Superselective cannulation of the anomalous thymic artery was done using a microcatheter with subsequent coil embolization.
Post-coiling, the bleeding stopped immediately and the patient recovered. He was under oncology care till 3 months following embolization and was doing well.
The emergency physicians should be aware of this rare variation of thymic artery while performing tracheostomy. Ultrasound as point-of-care device may help mitigate these complications. Endovascular embolization is a minimally invasive and effective management option for an injured arterial branch from a tracheostomy.
气管切开相关的动脉出血可能是毁灭性的，尤其是如果出血源自隐匿性异常血管，这可能会使治疗决策复杂化。
我们报告了一例非霍奇金淋巴瘤患者，该患者因上呼吸道阻塞而行气管切开术，术后气管造口部位出现大量出血。CT 血管造影显示，气管切开部位附近存在假性动脉瘤，导管血管造影证实其来自右颈总动脉（CCA）异常胸腺支。使用微导管对异常胸腺动脉进行超选择性插管，随后进行线圈栓塞。
栓塞后，出血立即停止，患者恢复。栓塞后 3 个月他一直在接受肿瘤学治疗，情况良好。
在进行气管切开术时，急诊医生应该意识到这种罕见的胸腺动脉变异。超声作为即时护理设备可能有助于减轻这些并发症。血管内栓塞是治疗气管切开术所致损伤性动脉分支的一种微创、有效的治疗选择。
