Fatal hemoptysis from coil migration after endovascular coil embolization of a pseudoaneurysm years after anterior thoracolumbar scoliosis correction despite the acceptable original position of the screw: An autopsy case report

摘要

IntroductionFatal hemoptysis due to pseudoaneurysm development of the aorta following spinal screw instrumentation to correct scoliosis is a very rare clinical presentation.Case presentationWe present an autopsy case of a 75-year-old German woman with a rare clinical presentation due to delayed aortic pseudoaneurysm that developed over years by compression of a screw head that was appropriately positioned. This aneurysm occurred years after scoliosis correction using anterior spinal instrumentation and lateral vertebral body screws. She was admitted to the hospital with abdominal and back pain. Her computed tomography (CT) and magnetic resonance imaging showed a hematoma of the paravertebral muscle at level Th12. Subsequently, diagnostic angiography was performed, which showed a paravertebral pseudoaneurysm with an aortic laceration approximately 3?cm in size. Interim emergency coil embolization was performed. Before a definitive endovascular stent could be placed the patient demised due to fatal hemoptysis. The autopsy revealed aortic wall injury, intra-alveolar, fresh pulmonary hemorrhage, a detachable coil at the site of the aortic rupture and migration of coils to the pulmonary parenchyma. Change of the diaphragm with fistula. The head of the internal fixator screw was seen in the hole through the aortic wall.ConclusionsIf direct contact between the aorta and a fixation screw following spinal surgery is identified in the postoperative course, such a rare complication should be considered and appropriate imaging (CT) on regular follow-up should be performed.