TS has proven to be highly efficient in the treatment of palmar hyperhidrosis resisting to conservative treatment. Success rate ranging from 95–98% with lasting good long-term results have been reported 3,4, 5. Nevertheless, various complications such as pneumothoraces in 7%, hemothoraces in 1%, paresthesia in up to 50% and Horner’s Syndrome in 1% to 2,5% were described3,4. Moreover, compensatory hyperhidrosis appears to be the main long-term complication with an incidence of 30 to 85% 2,3,4,5.
It is noteworthy that false aneurysms have never been reported after TS, however.
Only two cases of delayed intercostal artery pseudoaneurysm after thoracoscopy were reported in the English literature. Both cases presented with a large hemothorax after intercostal artery pseudoaneurysm rupture and required surgical attention13,14. Conversely to intercostal artery pseudoaneurysm, there are no reports of TDAP after thoracoscopic surgery.
Interestingly, two non-thoracoscopic related cases of TDAP have been previously described. One resulted from fibromuscular dysplasia15 while the other occurred after latissimus dorsi free flap surgery16.
Pseudoaneurysms have a variety of causes including inflammation, infection, blunt or penetrating trauma. Surgery can result in pseudoaneurysms through direct vessel injury or the introduction of infection. In our case, we hypothesize that trocar insertion caused arterial wall continuity disruption with constitution of a blood collection between the two outer artery layers, the adventitia and the media, which over time led to symptomatic TDAP development.
In our case, TDAP presented as a painful non-pulsatile axillary lump that could have been easily confused with a variety of other soft tissue masses. Thus, exposing the patient to misdiagnosis and mismanagement.
As an initial diagnostic modality, US picked up a pseudoaneurysm which thoracodorsal origin was detailed by CTA. Definitive diagnosis was made by DSA at the time of treatment.
In recent years, the traditional surgical management of pseudoaneurysm has been widely replaced by endovascular approaches17. Embolization by metallic coils and other materials such as hemostatic particles, glue, thrombin, polyvinyl alcohol have become generalized14. Moreover, US-guided thrombin injection in PA offers an additional interesting minimal invasive option17,18.