Spontaneous Hemomediastinum Complicating Steroid-Induced Mediastinal Lipomatosis

Mediastinal hematomas are the end result of numerous conditions ranging from the deadly traumatic aortic injury to the common changes after open heart surgery. The location of the hematoma, its relation with the surrounding structures, the clinical history, and associated findings can help narrow the differential diagnosis. Contrast-enhanced computed tomography is the imaging modality of choice because of its accessibility, noninvasiveness, rapid acquisition, and ability to evaluate the entire thorax at once.

Mediastinal hematomas: aortic injury and beyond.

A bronchial artery aneurysm (BAA) is uncommon and usually associated with chronic inflammatory lung disease or a systemic vascular condition, which is rarely the etiology of mediastinal hemorrhage. A middle-aged person presented with spontaneous hemothorax and hemomediastinum. A diagnostic evaluation identified a bronchial artery aneurysm as the source. To prevent further rupture, we performed a bronchial artery embolization. In the absence of trauma or other causes for hemothorax and mediastinal hemorrhage, the possibility of a BAA should be considered. A bronchial artery aneurysm can be managed by interventional techniques as well as surgery.

Spontaneous hemomediastinum and hemothorax caused by a ruptured bronchial artery aneurysm.

Spontaneous hemomediastinum is a rare pathological event due to bleeding disorders, mediastinal organ hemorrhage or idiopathic causes. It usually presents with chest pain and dyspnea, which can lead to confusion with other clinical conditions. The election diagnostic method is computed tomography and treatment depends on underlying etiology, aimed on controlling hemorrhages, if present. In this paper, we present a case of spontaneous hemomediastinum and hemothorax after bronchial artery aneurysm dissection treated with endovascular embolization and chest drainage.

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Spontaneous hemomediastinum and hemothorax after dissecting bronchial artery aneurysm

Hematemesis is a rare manifestation of a ruptured bronchial artery aneurysm (BAA) in the mediastinum It is difficult to diagnose a ruptured BAA presenting as hematemesis, because it can be confused with other diseases, such as Boerhaave’s syndrome, variceal disease, or a perforated ulcer In this report, we describe a case of BAA resulting in hematemesis and mediastinal hemorrhage

Bronchial Artery Aneurysm Presenting as Hematemesis and Mediastinal Hemorrhage

A patient on chronic hemodialysis presenting with shortness of breath and dysphagia was found to have massive hemomediastinum. A review of the world's literature prompted by this case reveals that this rare entity can be classified into three general groups: (1) hemomediastinum secondary to underlying bleeding disorder, (2) hemomediastinum secondary to hemorrhage into a mediastinal organ or gland, without underlying bleeding disorder and (3) idiopathic hemomediastinum, without underlying bleeding disorder. Therapy depends upon the underlying etiology and the severity of symptoms.

R B Wagner

Papers

Spontaneous mediastinal hemorrhage: a case report with a review of the literature.