Fig. 3

Relationship between the bleeding site of the fifth intercostal artery and the staple line. a Frontal view, b right anterior oblique view showing the relationship between the staple line (white) and the fifth intercostal artery (light green) reconstructed based on the CT scan from one month before hemothorax onset. c Sequential axial images showing the staple line (blue arrow) and the fifth intercostal artery originating from the aorta (light green arrowhead) crossing each other. d Frontal view, e right anterior oblique view of reconstructed contrast-enhanced CT scan at onset showing the disrupted fifth intercostal artery and the contrast medium leaking into the thoracic cavity. The intact part of the fifth intercostal artery indicated by white line, and the bleeding point indicated by white arrowhead. The staple line from the past pneumothorax surgery aligns with the fifth intercostal artery, and the bleeding point was exactly the same location. Despite a shock vital with BP 50/30 and HR 120, an approximate blood loss of 40 mL/min was measured. All of the contrast medium leaked out at the bleeding point, and the peripheral fifth intercostal artery beyond the bleeding point was not visualized