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.