A Rare Case of Spontaneous Hemomediastinum Due to Internal Mammary Artery Pseudoaneurysm in a Patient With Neurofibromatosis Type 1
Bibliographic record
Abstract
Abstract This report describes a case of a 48-year-old female with Neurofibromatosis Type 1 (NF1, von Recklinghausen's disease) and a malignant peripheral nerve sheath tumor, for which she was on chemotherapy. The patient was admitted with acute respiratory failure secondary to healthcare-associated pneumonia and decompensated systolic heart failure. During hospitalization, he developed sudden tachycardia, diminished breath sounds on the right side with a hemoglobin drop of 2.4g/dL, suggesting a possible acute intrathoracic event. A chest X-ray revealed widened mediastinum, prompting Computed Tomography scan( CT scan )that showed right paramediastinal hematoma and pseudoaneurysm arising from the right internal mammary artery (IMA). This finding was atypical, as spontaneous mediastinal hematomas in NF1 most frequently involve the intercostal, subclavian or bronchial arteries. Immediate management included transfusion of three units of packed red blood cells. Urgent discussion about embolisation and hematoma evacuation was held however patient opted for conservative management given his general poor health. This approach focused on close monitoring, blood products transfusion support as needed, and hemodynamic stabilization. Over a 14-day course, the patient improved steadily without further bleeding or hemodynamic instability. At discharge, her haemoglobin had stabilized at 8.4 g/dL, and she was in a stable condition. Spontaneous hemomediastinum is an uncommon and potentially life-threatening complication, with pseudoaneurysmal rupture of the IMA being especially rare. NF1, a genetic disorder marked by benign neurofibromas along peripheral nerves, predisposes individuals to vascular abnormalities through vessel wall dysplasia, which increases the risk of spontaneous vessel rupture. Notably, the involvement of the internal mammary artery is extremely unusual, with only two other case documented in medical literature. This case emphasizes the need for heightened vigilance regarding vascular complications in NF1 patients, especially those undergoing chemotherapy, as they may have an elevated risk of such events. This case contributes to the limited data on spontaneous hemomediastinum in NF1 patients and highlights conservative management's potential role when surgical intervention is deferred. Further studies are warranted to elucidate underlying mechanisms and to establish optimal management strategies for spontaneous vascular events in NF1 patients. Keywords: Spontaneous Hemomediastinum, Internal Mammary Artery Rupture, Neurofibromatosis Type1, Pseudoaneurysm.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".