A 70-year-old male with a history of prostate adenocarcinoma 7 years ago (T2a-b N0 M0) was treated with androgen deprivation, radiotherapy and brachytherapy.
Surgery was performed to treat the arachnoid cystectomy and cystectomy.
Without regular medication, as a relevant family history, the patient had a sister affected by breast cancer and a brother with lung cancer.
He came to the emergency service due to sudden onset transfixive chest pain associated with vegetative courtship while performing agricultural work.
During her stay in the Emergency Room 64 bpm was asymptomatic and hemodynamically stable.
The examination revealed mucocutaneous auscultation, cardiac auscultation with rhythmic apagated tone without murmurs, and the rest of the examination was normal.
The initial laboratory analysis showed normal blood count with biochemistry and anodyne coagulation parameters, DD = 189 ng/ml (0-275), Natriuretic peptide type B 80 pg/ml (0-100), troponin- 0.008.
In the initial chest X-ray (RX), the patient presented mediastinal widening. Consequently, an urgent CT scan of the aorta was performed, which revealed a bilateral pleural effusion, including a retrofield esophagus 38 - bl tissues.
Hemorrhagic cytology findings of the imaging test was initially admitted to the Digestive Appliance Service where echoendoscopy was performed visualizing a heterogeneous lesion posterior to the esophagus without depending on it, taking biopsy with negative result.
A bronchoscopy was performed, describing abundant compression level distal tracheal wall cells and main bronchi, performing 3 punctures with exit of hemorrhagic material, with hemorrhagic cytology.
Pathologic examination was performed to obtain samples.
Hb/g. a stable level of Hb found in the tests performed prior to surgery, an interconsultation was made with the Internal Medicine Department, who reviewed the clinical history since admission and later experienced anemization in the first hours of admission (Hb 14
A new chest X-ray showed disappearance of mediastinal widening with minimal persistence of pleural effusion.
Conservative diagnosis was performed with negative results for neoplasia with hemorrhagic cytology.
Given the initial clinical presentation and the results of hemorrhagic cytology and the high suspicion of vascular complication at the thoracic level, a new CT was requested and reported as a small image of hypodense and homogeneous aspect with a caliber of approximately 1.5 cm compatible with hematoma.
Angiography showed pseudoaneurysmal dilation of the bronchial artery at its origin, requiring therapeutic embolization without incidents.
