Case 1
A 74-year-old man presented underwent uneventful implantation of a
cardiac resynchronization defibrillator (CRTD). Extra‐thoracic puncture
of the axillary vein in the region of the first rib was performed using
fluoroscopic guidance. Approximately 3 hours post implantation the
patient was noted to have significant pectoral swelling associated with
pain (Figure 1A). Despite 1 hour of continuous manual pressure, there
was ongoing expansion in the pectoral region with an associated decrease
in hemoglobin from 13.8 to 10.4g/d.
A computed tomography angiogram scan of the thorax was performed. A
large hematoma in the region of the pectoralis major muscle and
extending into the left axilla region was noted with contrast
extravasation into the hematoma suggesting active arterial bleeding from
the thoracoacromial branch of the left axillary artery (Figure 1B).
After discussion with vascular surgery and interventional radiology,
coil embolization was performed (Figure 1 C, D). The hematoma no longer
expanded, and slowly resolved over the ensuing week.