PMC6320353_01
SPECT/CT 99mTc-MDP bone scan. a Axial CT image shows three extrapleural nodules (arrows) adjacent to the T7 vertebral body, which has a notched appearance (*). b Axial fused SPECT/CT image demonstrates no evidence of proximate bony metastatic disease
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Fig1
During this workup, a SPECT/CT scan noted vertebral body notching and multiple extrapleural nodules (Fig. 1).
CT angiography. a Axial CT image shows three dense nodules and eccentric lower attenuation material (arrows) consistent with thrombus containing aneurysms of the proximal right 7th intercostal artery, the largest measuring 2.1 cm x 1.8 cm. b Three-dimensional reconstruction shows multifocal aneurysmal dilatations at multiple levels (arrows)
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Fig2
Further evaluation with CT angiography revealed multifocal saccular and fusiform aneurysms of the intercostal arteries (Fig. 2).
Selective intercostal angiography with digital subtraction. a Aneurysms of the right 7th intercostal artery prior to embolization, b after distal occlusion with microcoils, and c following complete exclusion of the aneurysm sacs with microcoils and glue
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Fig3
Angiography confirmed the target aneurysms of the 7th intercostal artery (Fig. 3a) and that no spinal artery originated from them. A Renegade microcatheter (Boston Scientific, Cork, Ireland) was inserted and Interlock microcoils (2 of 2 mm x 6 mm x 8 cm, Boston Scientific, Cork, Ireland) were deployed starting distally (Fig. 3b). Proximally, Interlock microcoils (2 of 2 mm x 4 mm x 4.1 cm, Boston Scientific, Cork, Ireland) were placed and complete cessation of flow was achieved (Fig. 3c).