Volume. 35, No. 2 july. 2011 - The Chest and Heart Association of ...

Chest & Heart JournalVol. 35, No. 2, July 2011CASE REPORTSubclavian Artery Pseudoaneurysm in aNonagenarian Man after Closed Fracture of theClavicle- A Case ReportMd. Saif Ullah Khan 1 , Md. Naimul Hoque 2 , Md. Mahbubur Rahman 3Abstract:A ninety-year-old man was admitted with a subclavian artery pseudoaneurysm(PSA) after a closed fracture of the middle third of the right clavicle. Thismanifested itself a few days after the injury as a slowly growing, pulsatile andtumour-like mass in the right supraclavicular fossa. The distal pulses were normal.This is an uncommon but potentially dangerous complication as it jeopardizesboth the extremity and the life of the patient.[Chest & Heart Journal 2011; 35(2) : 132-134]Introduction:Injuries to the brachial plexus and subclavianartery are serious complications of shoulder girdletrauma. Due to the close anatomical relationshipbetween the brachial plexus and the subclavianartery in the thoracic outlet, both structures areoften simultaneously involved in shoulder girdleinjuries. Isolated lesions of the subclavian arteryor the brachial plexus can also occur, especiallywith clavicular fractures. When a false subclaviananeurysm leads to a gradually increasingcompression of the brachial plexus, theneurological signs and symptoms developinsidiously after the traumatic. Vascularcomplications in closed clavicular fractures are veryuncommon 2,3,4 . In a series published only two outof 93 patients with an injury of the subclavianvessels had a clavicular fracture 5 . Duplex scan canconfirm diagnosis of pseudoaneurysm. Criteria fordiagnosis of pseudoaneurysm sac are;extravascular arterial sac with flow,communication between sac and artery and toand-frosignal in the neck of PSA . In addition theproximal native artery of origin may have a lowerresistance spectral waveform when compared withthe distal artery.Case Report:A 90-year-old man was seen in a district hospitalafter a fall on the right shoulder following RTA.The radiographs showed a displaced fracture of theFig.-1:Tumour-like mass in the rightsupraclavicular fossa1. Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka.2. Department of Respiratory Medicine, National Institute of Diseases of the Chest & Hospital, Dhaka.3. Professor, Department of Vascular Surgery, BSMMU, Dhaka.Correspondence to: Md. Saif Ullah Khan, Department of Vascular Surgery, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka