Internal thoracic artery aneurysm coincidental with protein S deficiency: a case report
Dublin Core
Title
Internal thoracic artery aneurysm coincidental with protein S deficiency: a case report
Subject
Internal thoracic artery, Aneurysm, Protein S deficiency, Nephrotic syndrome, Hemodynamic stress
Description
Abstract
Background Internal thoracic artery aneurysms are exceptionally rare and carry a risk of fatal rupture. Although
pseudoaneurysms are commonly associated with trauma or surgical interventions, the development of true
aneurysms promoted by thrombotic disorders has not been previously reported.
Case presentation A 61-year-old man undergoing hemodialysis for end-stage renal disease due to untreated
nephrotic syndrome presented with hemoptysis. He had a medical history of deep vein thrombosis and was taking
warfarin. Imaging studies revealed pulmonary embolism, systemic collateral circulation, a 21-mm aneurysm of the
left internal thoracic artery, and a 9-mm aneurysm of the left bronchial artery. Laboratory investigations confirmed
acquired protein S deficiency, likely caused by nephrotic syndrome. The internal thoracic artery aneurysm, due
to concern for rupture, was successfully treated with percutaneous catheter arterial embolization, while the left
bronchial arterial aneurysm was managed conservatively without intervention because of its small size. The patient
recovered without complications and remained stable during a 5-year follow-up.
Conclusions This case highlights a rare presentation of internal thoracic artery aneurysm coinciding with acquired
protein S deficiency and nephrotic syndrome. Although a direct causal relationship between protein S deficiency and
aneurysm formation is difficult to establish, the co-occurrence of these conditions underscores the importance of
careful vascular assessment in similar patients.
Keywords Internal thoracic artery, Aneurysm, Protein S deficiency, Nephrotic syndrome, Hemodynamic stress
Background Internal thoracic artery aneurysms are exceptionally rare and carry a risk of fatal rupture. Although
pseudoaneurysms are commonly associated with trauma or surgical interventions, the development of true
aneurysms promoted by thrombotic disorders has not been previously reported.
Case presentation A 61-year-old man undergoing hemodialysis for end-stage renal disease due to untreated
nephrotic syndrome presented with hemoptysis. He had a medical history of deep vein thrombosis and was taking
warfarin. Imaging studies revealed pulmonary embolism, systemic collateral circulation, a 21-mm aneurysm of the
left internal thoracic artery, and a 9-mm aneurysm of the left bronchial artery. Laboratory investigations confirmed
acquired protein S deficiency, likely caused by nephrotic syndrome. The internal thoracic artery aneurysm, due
to concern for rupture, was successfully treated with percutaneous catheter arterial embolization, while the left
bronchial arterial aneurysm was managed conservatively without intervention because of its small size. The patient
recovered without complications and remained stable during a 5-year follow-up.
Conclusions This case highlights a rare presentation of internal thoracic artery aneurysm coinciding with acquired
protein S deficiency and nephrotic syndrome. Although a direct causal relationship between protein S deficiency and
aneurysm formation is difficult to establish, the co-occurrence of these conditions underscores the importance of
careful vascular assessment in similar patients.
Keywords Internal thoracic artery, Aneurysm, Protein S deficiency, Nephrotic syndrome, Hemodynamic stress
Creator
Tomoya Sano1
, Yohei Maki1*, Hiroaki Sugiura2
, Eriko Morishita3
, Hiroshi Shinmoto3
, Akihiko Kawana1
and
Yoshifumi Kimizuka1
, Yohei Maki1*, Hiroaki Sugiura2
, Eriko Morishita3
, Hiroshi Shinmoto3
, Akihiko Kawana1
and
Yoshifumi Kimizuka1
Source
https://doi.org/10.1186/s12245-025-00909-0
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Tomoya Sano1
, Yohei Maki1*, Hiroaki Sugiura2
, Eriko Morishita3
, Hiroshi Shinmoto3
, Akihiko Kawana1
and
Yoshifumi Kimizuka1, “Internal thoracic artery aneurysm coincidental with protein S deficiency: a case report,” Repository Horizon University Indonesia, accessed April 13, 2026, https://repository.horizon.ac.id/items/show/12817.