Tumour derived its blood supply as direct branches from internal mammary and anterior intercostal arteries
. Mass had no feeding vessels in the neck.
Secondary sources such as posterior intercostal arteries
, subcostal artery, and lumbar arteries provide blood supply.
In this path, the lateral costal branch establishes anastomosis with the posterior and anterior intercostal arteries
of the first to eighth intercostal spaces through two fine branches, generating an intermediate longitudinal vascular axis for these arteries, as well as emitting direct branches for the thoracic wall, forming part of the arterial circuit of this wall.
Diagnostic angiography was routinely performed during the embolotherapy procedure to exclude the presence of spinal arteries arising from the bronchial or intercostal arteries
. Spinal arteries, if found were not considered a contraindication to embolisation.
However, these adult patients have developed significant collateralization through intercostal arteries
and are at increased surgical risk secondary to bleeding complications.
CT chest (Figure 2) and subsequent intercostal arteriogram of T6-T12 intercostal arteries
showed active contrast extravasations from the right T7 intercostal artery (Figure 3), right T8 intercostal artery, and small branch arising from right T10 intercostal artery.
For the patient with pancreaticopleural fistula, reported with hemoptysis 2 weeks after intercostal drainage, CT-angiogram showed multiple pseudoaneurysm involving inferior phrenic and lower intercostal arteries
which was eventually managed with angioembolisation with coils (Figure 8), while another patient with infected pseudocyst developed splenic artery pseudoaneurysm in the follow-up period and required angioembolisation (Figure 9).
The middle esophageal blood supply is derived from the bronchial arteries, right third or fourth intercostal arteries
, and numerous small esophageal arteries off the descending aorta.
To exemplify, the order of the arteries branching from the subclavian artery is the axillary, coracoid major, pectoral and intercostal arteries
in the Grus americana (whooping crane) (Fisher, 1955), the axillary, pectoral, intercostal and coracoid major arteries in the Grus antigone (sarus crane) (Glenny, 1947), and the sternoclavicular artery, axillary artery and thoracic trunk in the Eurasian bittern (Erdogan, 2012).
These maintain blood supply and adequate perfusion pressure in intercostal arteries
. So, spinal cord ischemia and other neurological complications are avoided.
Subpleural interstitial thickening was evident in the right lung secondary to collateral intercostal arteries
. Both lung fields were symmetrical in size and no mosaic perfusion was noted.