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Objective: Toreportposteriormediastinalhematomawithanuncommoncauseandsummarytherapeuticexperiences. Methods: Thiswasaretrospective,descriptivereviewofararecasewithspontaneousmediastinalhematoma. Results: A61-year-oldmanwitha2-dayhistoryoffatigue,excessivesweat,mildchestandepigastricpain,wasadmittedtoour hospital.Hehadnosignificantpastmedicalorsurgicalhistory,exceptforchronicbronchitisandbronchiectasis20years previously.Chestauscultationrevealedcrepitationsinbilateralbasallungarea.Acompletebloodcellcountindicatedanelevated whitebloodcellcountof16.15×109/Lbutmilddecreasedhemoglobinof103g/L.Chestcomputedtomographyshowedalarge mixed-densityposteriormediastinalmassextendingfromthelevelofgastriccardiatoaorticarchtogetherwithbilateralpleural effusion.Cysticbronchiectasiswasalsoseeninbothlung,predominantlyintheleftlowerlobe.Subsequentcontrast-enhancedCT revealedmassivemediastinalhematomaandananeurysmmainlyoriginatingfromthebranchofleftgastricartery(Fig2).Onday twoofadmission,repeatedbloodtestdemonstratedadecreasedhemoglobinvaluefrom103g/Lto86g/L,suggestingactive bleeding.Emergentsuper-selectiveangiographyofleftgastricarteryrevealedananeurysmmeasuring10mmindiameterlocated intheinferior-posteriormediastinumwithcontrastmediumleakage,feedingvesselsrespectivelyfromcaudalandcranialartery. Transcatheterarterialembolizationwasperformedviaacoaxialcathetertechnique,andalongsegmentoftheleftgastricartery branchfeedinganeurysmwassuccessfullyoccludedwithfivemicro-coilsandgelatinspongeparticles.Then,cranialfeeding arteryofmediastinalaneurysmwascompletelysearchedandthebranchoftheleftbronchialarterywassuspectedtobethe culprit.Leftbronchialarteryoriginatedfromtheconcavesideofproximalleftsubclavianarteryandcoursedtortuously.The embolizationwascancelledbecausecoaxialcatheterfailedtobeintroduced.Aftertheprocedureoftranscatheterembolization, thepatientimmediatelyrecoveredfromhemodynamicinstabilitywithoutanydropathishemoglobinlevelonconsecutive5days andwasdischargedhomeonthe7thday.Atthe1-monthfollow-upperiod,contrast-enhancedCTshoweddecreasedsizeof mediastinalhematomameasuring18.1cm×7.4cm×3.6cm.At1-yearfollow-up,herecoveredtonormalconditionwithcomplete absorption. Conclusion: Spontaneousmediastinalhematomaisdefinedasmediastinalhematomaoccurringwithoutapparentexternalcause. Inthosepatients,underlyingpredisposingfactorssuchasabnormalhemostasis,mediastinal/lowercervicalneoplasms,and vasculopathiesarefrequentlycommon.Asuddenincreaseinintrathoracicpressuresuchascoughing,sneezing,orvomitingcan causemediastinalhematoma.Uncontrolledcoughfrombronchiectasismayfacilitatemediastinalsmallaneurysmruptureinour patient.Currently,chestCTscanisthemostfrequentlyusedmodalityinevaluatingthosesuspectedpatientswithmediastinal hematomabecauseitcanallowforarapidandnoninvasiveevaluationofthemediastinumandadjacentstructure.Contrastenhanced CT,especiallyCTangiography,allowsbetterimageswithrespecttothedepictionofectopicbronchialarteriesand nonbronchialsystemiccollateralarteries.Toourknowledge,mediastinalhematomafromrupturedaneurysmofthebranchofleft gastricarteryisnotdocumentedintheliterature.GiventhispatientshistoryandfindingsonCTimaging,itislikelythathis aneurysmoccurrencewasrelatedtolong-termbronchiectasis.Asknown,chronicinfectiouslungdiseasessuchasbronchiectasis frequentlyresultinwell-developedcollateralcirculationofbronchialandnon-bronchialsystemicarteries.Managementof mediastinalhematomacentersaroundsurgeryandconservativemanagement.Now,less-invasiveembolizationismoreandmore preferred.Inourpatient,onesidearterysupplyinganeurysmwasembolizedandyieldedtoasatisfactoryoutcome,whilethe branchofleftbronchialarteryfailedtobeembolizedandremaineduntreated.Accordingtoourspeculation,circularpassageof aneurysmwascutoffandthedecreaseofaneurysmpressurewasnotenoughtofacilitatebloodextravasation. Collateralcirculationofbronchialandnon-bronchialsystemicarteriesisresponsiblefortheoccurrenceofmediastinalaneurysm andconsequentbleeding.Transcatheterembolizationisafeasibleandeffectivetreatmentoption.