[A case of ruptured bronchial artery aneurysm with hemothorax and mediastinal hematoma]

We encountered a case of ruptured bronchial artery aneurysm, which presented with hemothorax and mediastinal hematoma. The patient was a 65-year-old man. He was admitted because of a sudden onset of right chest pain. The chest X-ray film revealed a right pleural effusion and a pleural tap was reported to be bloody. Chest contrast CT revealed a subcarinal mass and several nodes, about 10 mm in diameter, in the thyroid. Because fine needle aspiration of the thyroid was positive, we suspected that the mediastinal lesion was a metastatic lymph node, and that the ruptured metastasis and carcinomatous pleurisy might have caused the hemothorax. However, mediastinoscopy confirmed no tumor but only mediastinal hematoma. This made us strongly suspect ruptured bronchial artery aneurysm. We next performed selective angiography of the bronchial artery, revealing an aneurysm, 10 mm in diameter. On this basis, a definitive diagnosis of ruptured bronchial artery aneurysm was made. Since the feeding vessel was too narrow to cannulate for embolization, we performed video-assisted thoracic surgery to dissect the hematoma. Although it was too organized to identify the aneurysm, it was assumed to be have been removed, and no recurrence was observed after the operation. Since a rupture of the bronchial artery could be life-threatening, a ruptured bronchial artery aneurysm should be considered as one of the differential diagnoses of hemothorax.