PMC5842741_01
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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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.
Chest radiography (AP orientation) demonstrating a widened superior mediastinum.
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Next, chest radiography was promptly obtained, which revealed a markedly widened superior mediastinum (Figure 2).
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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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)).
Angiography of the brachiocephalic artery demonstrating a small pseudoaneurysm (a). There was an excellent angiographic result after deployment of a covered stent (b).
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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)).