Ipsilateral Recurrent Hemothorax Caused by Spontaneous Intercostal Artery Rupture Treated With Transcatheter Arterial Embolization and Video‐Assisted Thoracoscopic Surgery: A Case Report

Hemothorax caused by intercostal artery rupture is a potentially life-threatening disease. A 66-year-old woman presented to our emergency department with left back pain. She had undergone surgery for left hemothorax 14 years ago. Contrast-enhanced chest computed tomography revealed active bleeding from the left dorsal ninth intercostal artery near the descending aorta. Subsequently, she developed hypovolemic shock. Based on her medical history, the patient was suspected of having adhesions in the left thoracic cavity. Surgery was considered a time-consuming approach to control the bleeding. Our first treatment choice was transcatheter arterial embolization, which could control the bleeding. Subsequently, we performed video-assisted thoracoscopic surgery for a left large-volume hemothorax. The patient had no severe postoperative complications. Upfront transcatheter arterial embolization followed by video-assisted thoracoscopic surgery for recurrent hemothorax may be an effective, minimally invasive treatment strategy, particularly when surgical hemostasis is expected to be time-consuming.