Traumatic intercostal artery pseudoaneurysm following a bicycle accident

In this article we present a fatal case of a ruptured intercostal artery pseudoaneurysm that occurred a number of years after an incident in which the patient suffered a blunt-trauma injury. A long interval between blunt trauma and this type of fatality has rarely been reported. This case discusses a 49-year-old woman who was found dead at her home by her husband and was referred for autopsy because the cause of death was uncertain. Her past medical history was unknown; however, it was learned that she had a bicycle accident 4years previously and had sustained injuries to the left side of her body. During the autopsy, healed fractures in the bones of the left lower rib cage and a large amount of blood in the left thorax were observed. Furthermore, a hematoma, containing a small rupture was found in the left tenth intercostal space adjacent to the thoracic vertebrae. Histological examinations showed that the wall of the left tenth intercostal artery was ruptured, with recent blood clots including fibrin. Additionally, in the lesion where the tunica adventitia was disrupted, the dissecting cavity was filled with blood. We concluded that the woman died of hemorrhagic shock resulting from a ruptured intercostal artery pseudoaneurysm that formed as a result of the injury incurred from the bicycle accident 4years before.