Presentation
Right shoulder pain and shortness of breath several hours after giving birth. Suspected pulmonary embolism.
Patient Data
No evidence of embolus in the main pulmonary arteries or the segmental arteries.
Large amount of right pleural fluid with a huge thrombus, displacing the mediastinum and the heart to the left and the right hemidiaphragm downwards. Most of the right lung is collapsed.
Pseudoaneurysm in the right internal thoracic artery (RITA) near its origin with active bleeding.
Case Discussion
This young woman with neurofibromatosis type 1 complained of postpartum shortness of breath and right shoulder pain. CTPA (actually done in early portal phase) revealed a ruptured right internal thoracic artery (RITA) pseudoaneurysm, probably due to the intense positive pressure exerted by the patient during delivery.
If you look closely, the patient also has several cutaneous fibromas.