Bilateral internal thoracic artery injury induced by blunt trauma

A case is reported of a 52-year-old man with bilateral internal thoracic artery (ITA) injury induced by blunt trauma. He was a laborer at a construction site who was hit on the anterior chest by a ceiling block. On arrival at the hospital at one hour after the accident, his general condition was good, and the chest computed tomography (CT) showed a slight hematoma at the mediastinum. However, at 4 hours after the trauma, the blood pressure fell, and the CT showed a large anterior mediastinal hematoma with bilateral hemothorax. A median sternotomy revealed bilateral ITA injury at the level of the 3rd intercostal space and incomplete fractures in the sternum and bilateral rib cartilages. Although hemostasis was achieved by ligation of the injured ITA, bleeding re-occurred from the ITA at the level of the 2nd intercostal space, and this was stopped by a second operation. The patient recovered without any further significant complication. The rarity of blunt trauma-induced ITA injury is discussed, including the mechanism, diagnosis, and treatment.