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. 2020 Mar 8;21:e920196.
doi: 10.12659/AJCR.920196.

Superficial Stab Wound to Zone I of the Neck Resulting in Thyrocervical Trunk Pseudoaneurysm Presented as Recurrent Hemothorax and Successfully Managed by Coil Embolization

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Free PMC article

Superficial Stab Wound to Zone I of the Neck Resulting in Thyrocervical Trunk Pseudoaneurysm Presented as Recurrent Hemothorax and Successfully Managed by Coil Embolization

Adel Elkbuli et al. Am J Case Rep. .
Free PMC article

Abstract

BACKGROUND Thyrocervical trunk pseudoaneurysms are rare complications that have been documented after internal jugular or subclavian venous cannulation. Even less common, these pseudoaneurysms can arise after blunt or penetrating trauma. Clinical hallmarks include an expanding supraclavicular mass with local compressive symptoms such as paresthesias, arterial steal syndrome, and Horner's syndrome. Patients may be asymptomatic, however, or present with overlying ecchymosis or the presence of a new bruit or thrill. With the risk of rupture, thyrocervical trunk pseudoaneurysm is associated with significant morbidity and mortality. CASE REPORT We report the case of a 27-year-old man who presented after sustaining a self-inflicted stab wound to zone I of his neck. Initial examination revealed only a superficial small laceration, but a chest x-ray revealed a pneumothorax, and tube thoracostomy returned 300 mL of bloody output. After resolution of the hemothorax and removal of the thoracostomy tube, the patient reaccumulated blood, requiring a repeat tube thoracostomy. Angiography at that time revealed a pseudoaneurysm of the thyrocervical trunk, and coil embolization was performed to obliterate the pseudoaneurysm. CONCLUSIONS Thyrocervical trunk pseudoaneurysms can be asymptomatic, often have a delayed presentation, and can be life-threatening due to the risk of rupture and subsequent hemodynamic decline or airway compromise. While these pseudoaneurysms are well-known complications of deep penetrating injuries, they can also present following superficial penetrating injury to zone I of the neck. Selective angiography is the imaging modality of choice. Open surgical repair was traditionally the criterion standard for treatment; however, endovascular approaches are minimally invasive, feasible, and safer alternatives with reduced complications and are becoming more common.

Conflict of interest statement

Conflict of interest: None declared

Conflicts of interests

None.

Figures

Figure 1.
Figure 1.
The thyrocervical trunk is the second ascending branch of the subclavian artery, arising distal to the vertebral artery.
Figure 2.
Figure 2.
Karambit knife.
Figure 3.
Figure 3.
(A) Index trauma bay A-P CXR showing left-sided pneumothorax. (B) After tube thoracostomy, showing left lung “white-out” consistent with hemothorax.
Figure 4.
Figure 4.
Initial CT chest and neck with contrast showing moderate left hemothorax without evidence of contrast extravasation.
Figure 5.
Figure 5.
(A) Repeat CXR on hospital day 4. (B) CXR after chest tube removal on hospital day 4 demonstrating persistent opacification of left lung field. (C) CXR after tube thoracostomy placement after removal of chest tube due to “white-out” of the left chest due to bleeding.
Figure 6.
Figure 6.
CT chest with IV contrast, coronal view: (A) Evidence of arterial injury with active extravasation of contrast originating from the thyrocervical branch of the proximal left subclavian artery; a small pseudoaneurysm is seen at the thyrocervical branch. (B) A large amount of blood is seen in the left chest as a result of bleeding from the injury site of the thyrocervical trunk pseudoaneurysm; a thoracostomy tube is also in place in the left chest.
Figure 7.
Figure 7.
(A) Angiogram showing left subclavian artery and thyrocervical trunk branch of the proximal subclavian artery. Left subclavian-selective arteriogram demonstrates a pseudoaneurysm arising from a branch of the left thyrocervical trunk with contrast extravasation (arrow). (B) Selective catheterization of left thyrocervical trunk, angiogram, and coil embolization. The abnormal vessel/pseudoaneurysm was embolized using three 3-mm detachable micro-coils. (C) Successful coil embolization of left thyrocervical trunk branch. Post-procedure angiogram demonstrates complete occlusion of the abnormal artery with exclusion of the pseudoaneurysm. No active contrast extravasation.
Figure 8.
Figure 8.
Normal CXR on the day of discharge.

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