case_images: PMC5842741_01
case_images: Coronary angiography of the right coronary artery in the left anterior oblique view before (a) and after (b) percutaneous coronary intervention and drug-eluting stent placement.
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case_images: fig1
case_images: After routine diagnostic coronary angiography confirmed a severe stenosis in the distal RCA (Figure 1(a)), bivalirudin was administered. There was a good angiographic result of the distal RCA with no residual stenosis (Figure 1(b)). Immediately following completion of the procedure, the patient reported an episode of chest discomfort, a new cough, bilateral expiratory wheezes, and respiratory stridor.
case_images: Chest radiography (AP orientation) demonstrating a widened superior mediastinum.
case_images: CRIC2018-6790120.002.jpg
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case_images: fig2
case_images: Next, chest radiography was promptly obtained, which revealed a markedly widened superior mediastinum (Figure 2).
case_images: Computed tomography (CT) of the chest without intravenous contrast demonstrating a hyperdense region surrounding the trachea suggestive of an anterior mediastinal hematoma (a). Computed tomography (CT) of the chest with intravenous contrast demonstrating a small pseudoaneurysm arising from the inferior aspect of the brachiocephalic artery (b).
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case_images: fig3
case_images: The chest CT revealed a large hyperdense region surrounding the trachea suggestive of an anterior mediastinal hematoma, resulting in severe airway compression (Figure 3(a)). After intubation, a repeat CT of the chest with administration of intravenous contrast was notable for a small pseudoaneurysm arising from the inferior aspect of the brachiocephalic artery, as well as significant narrowing of the distal trachea below the endotracheal tube (Figure 3(b)).
case_images: Angiography of the brachiocephalic artery demonstrating a small pseudoaneurysm (a). There was an excellent angiographic result after deployment of a covered stent (b).
case_images: CRIC2018-6790120.004.jpg
case_images: PMC5842741_01_CRIC2018-6790120.004.jpg
case_images: fig4
case_images: Access was obtained in the left common femoral artery, and angiography of the brachiocephalic artery was performed, which confirmed the presence of a brachiocephalic artery pseudoaneurysm (Figure 4(a)). Following the intervention, there was an excellent angiographic result with preserved subclavian and carotid runoff (Figure 4(b)).