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We present the case of a 36-year-old woman with sudden-onset chest pain caused by a large haemothorax. It was discovered that this was likely secondary to a pseudoaneurysm in the seventh intercostal artery alongside mid-aortic syndrome with an aortic diameter of 3\u00a0mm. This patient had not previously been diagnosed and subsequently suffered a life-threatening complication. This case highlights delayed recognition and diagnosis of NF1 which ultimately resulted in life-threatening sequelae. We suggest noting higher index of suspicion of NF1 following identification of vasculopathy, and to consider earlier testing in atypical presentations.<\/jats:p>","DOI":"10.1093\/jscr\/rjag882","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:09:12Z","timestamp":1789988952000},"source":"Crossref","is-referenced-by-count":0,"title":["Delayed diagnosis of neurofibromatosis type I with an index presentation of haemothorax"],"prefix":"10.1093","volume":"2026","author":[{"given":"Isaac","family":"Roberts","sequence":"first","affiliation":[{"name":"Cardiothoracic Surgery, Royal infirmary of Edinburgh , 51 Little France Crescent Old Dalkeith Road, Edinburgh EH16 4SA ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Hughes","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery, Royal infirmary of Edinburgh , 51 Little France Crescent Old Dalkeith Road, Edinburgh EH16 4SA 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