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A 73-year-old man on warfarin for atrial fibrillation presented to the emergency department with a 1 week history of feeling generally unwell, breathlessness and 2 days of right sided chest pain. Symptoms were aggravated on his return flight from Spain. He was found to have a large loculated collection on chest x ray (fig 1). Following a pleural tap he collapsed. Approximately 2 litres of blood was drained via a chest drain. He became increasingly hypotensive and was transferred to the intensive care unit. Further imaging with computed tomography and angiography revealed an aneurysm of a right intercostal artery which had started to bleed under the effect of anticoagulation (fig 2). Pressure changes during the flight may have aggravated the bleed. The aneurysm was embolised and the patient was transferred for evacuation of the haematoma. He made an uneventful recovery and was discharged home after a short stay.
This article has been adapted from Abeykoon Oshaani, Boyle Adrian A. Intercostal aneurysm causing massive haemothorax Emergency Medicine Journal 2007;24:781
Competing interests: none declared
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