Transcatheter Embolization of A Dilated Left Internal Mammary Artery Supplying A Recurrent Chest Wall Angiolipoma in An Adolescent: A Case Report

Abstract

Background: Angiolipoma is a benign lipomatous tumor containing prominent vascular components. Although usually managed by surgical excision, recurrent or highly vascular lesions may present a challenging operative and bleeding-risk profile. We describe an adolescent with recurrent chest wall angiolipoma in whom transcatheter embolization was used to control a major arterial feeder.

Case presentation: A 14-year-old boy presented with a 2-year history of recurrent swelling over the left anterior chest wall associated with pain during exertion. He had undergone surgical excision and biopsy 5 years earlier, with histopathology showing angiolipoma, followed by another surgical excision 2 years before the current presentation for a similar recurrent lesion. Examination revealed a 5 × 5 cm swelling over the left lower anterior chest wall. Laboratory investigations were within normal limits. Contrast-enhanced CT/CT angiography demonstrated a highly vascular chest wall mass with a prominent arterial supply from the left internal mammary artery (LIMA), with additional diminutive feeders from the inferior epigastric and posterior intercostal arteries.

Intervention: Right femoral arterial access was obtained using a 6-F sheath. LIMA angiography demonstrated a markedly dilated LIMA measuring approximately 9 mm, branching below the fifth costal cartilage and supplying the hypervascular tumor. The distal LIMA measured approximately 5.6 mm before bifurcation. An 8-mm Amplatzer Vascular Plug II was deployed through a 5-F JR 3.5 catheter close to the fourth anterior intercostal artery. Final angiography showed complete occlusion of the LIMA supply to the tumor. Attempts to engage the left superficial epigastric artery were unsuccessful; because CT angiography showed only diminutive additional feeders, further embolization was not pursued.

Conclusion: Selective transcatheter embolization can provide effective control of a dominant arterial supply to a recurrent, hypervascular chest wall angiolipoma. Careful pre-procedural vascular mapping is important to identify dominant and minor feeders and to guide a targeted embolization strategy.