Intercostal Artery Laceration after Adrenal Mass Cryoablation

Abstract

We present a case of a 69-year-old male with profound Cushing's syndrome and hypercortisolemia secondary to a cortisol-secreting adrenocortical carcinoma. Patient was not a surgical candidate and subsequently underwent a successful posterior approach tumor cryoablation. The procedure was complicated by a T11 intercostal artery injury and hemothorax. The detection of the culprit injury was almost immediate and the quick response time, and treatment of the injury via an intercostal artery embolization was critical to limiting the patient's morbidity and mortality. This case discusses the technical challenges of a posterior-approach ablation, the pitfalls to avoid, and the importance of attaining rapid hemostasis.

Keywords

cryoablation - intercostal artery - hemorrhage - hemothorax

Publication History

Article published online:
20 July 2023

• References

• 1 Welch BT, Atwell TD, Nichols DA. et al. Percutaneous image-guided adrenal cryoablation: procedural considerations and technical success. Radiology 2011; 258 (01) 301-307
• 2 Espinosa De Ycaza AE, Welch TL, Ospina NS. et al. Image-guided thermal ablation of adrenal metastases: hemodynamic and endocrine outcomes. Endocr Pract 2017; 23 (02) 132-140
• 3 Venkatesan AM, Locklin J, Dupuy DE, Wood BJ. Percutaneous ablation of adrenal tumors. Tech Vasc Interv Radiol 2010; 13 (02) 89-99
• 4 Atwell TD, Wass CT, Charboneau JW, Callstrom MR, Farrell MA, Sengupta S. Malignant hypertension during cryoablation of an adrenal gland tumor. J Vasc Interv Radiol 2006; 17 (03) 573-575
• 5 Stone MJ, Venkatesan AM, Locklin J, Pinto P, Linehan M, Wood BJ. Radiofrequency ablation of renal tumors. Tech Vasc Interv Radiol 2007; 10 (02) 132-139
• 6 Helm EJ, Rahman NM, Talakoub O, Fox DL, Gleeson FV. Course and variation of the intercostal artery by CT scan. Chest 2013; 143 (03) 634-639