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Computed tomography (CT) scans of a 91-year-old man with thyroid ima artery injury. A, Arterial phase of contrast-enhanced CT showing a mediastinal hematoma with active arterial hemorrhage (arrow). B, Arterial phase of contrast-enhanced CT showing the thyroid ima artery originating from the brachiocephalic artery (arrow).
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Arterial phase of contrast-enhanced computed tomography (CT) revealed a mediastinal hematoma with active arterial hemorrhage (Fig. 1A). Based upon the arterial phase of contrast-enhanced CT, injury to the descending branch of the ThIA, which possibly originated from the brachiocephalic artery (Fig 1B), was suspected.
Angiography of a 91-year-old man showing the thyroid ima artery originating from the brachiocephalic artery and extending to the thyroid gland (arrow) and mediastinum (arrowhead). Extravasation was observed from the branch toward the mediastinum (circle).
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ThIA did indeed originate from the brachiocephalic artery (Fig. 2). To carry out TAE, the brachiocephalic artery was selected with 5-Fr catheterization (Headhunter catheter; Medikit, Tokyo, Japan) and then the ThIA branch was selected with a 2-Fr microcatheter (LIGHTHOUSE; Piolax, Yokohama, Japan). Extravasation was imaged (Fig. 2).