PMC6317841_01
Contrast-enhanced computed tomography before surgery showing an area of hyperdensity projecting into the esophagus consistent with an intercostal-bronchial trunk pseudoaneurysm (arrow).
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F1
The patient was stabilized, and computed tomography (CT) angiography of the chest, abdomen, and pelvis revealed a focal hyperdensity in the esophageal mucosa, which was originally interpreted by diagnostic radiology as a pill lodged in the esophagus (Figure 1).
Active, bleeding ulcer of the mid-esophagus.
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F2
However, upon removal of these clots, brisk bleeding was observed in the area (Figure 2).
Angiogram of the right intercostal-bronchial trunk (black arrow) demonstrating extravasation of contrast into the esophagus (red arrow). The blue arrow indicates the catheter in the thoracic aorta with the tip engaged in the intercostal-bronchial trunk.
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F3
Angiogram of the right ICBT showed the bleeding pseudoaneurysm with an arterioenteric fistula to the esophagus (Figure 3).
Esophagogastroduodenoscopy after 1 month revealing previously placed coils visible below the mucosa near the area of prior hemorrhage.
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F4
The previously placed coils were visualized (Figure 4).
Contrast-enhanced computed tomography follow-up demonstrates coil pack (arrow) and no active extravasation of contrast into the esophagus.
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F5
Follow-up CT of the chest revealed a stable coil pack between the esophagus and the aorta without abnormal contrast enhancement (Figure 5).