Spontaneous massive hemothorax due to inferior phrenic artery pseudoaneurysm: endovascular treatment approach

Abstract Inferior phrenic artery (IPA) pseudoaneurysms are highly uncommon and result from trauma, pancreatitis, or iatrogenic injury. However, rupture can lead to catastrophic hemothorax. The vessel’s deep location and non-specific symptoms make early identification a difficult task. We report a case of a 22-year-old woman who was undergoing antitubercular therapy and presented with the onset of acute dyspnea after a five-month history of wheezing and hemoptysis. Computed tomography angiography revealed a pseudoaneurysm originating from the left IPA and a massive left hemothorax. This pseudoaneurysm sac and the descending branch of the IPA were successfully embolized with a glue: lipiodol mixture, followed by hemothorax evacuation. The patient is asymptomatic at 2-month follow-up. Endovascular embolization minimizes morbidity and enables rapid recovery when anatomy is favorable. This report emphasizes the importance of cross-sectional imaging in the early diagnosis and treatment planning of atypical hemothorax presentations.