Blunt Traumatic Injury of the Innominate Artery Resulting in a Stroke - A Rare Presentation

Abstract

Introduction: Blunt traumatic injury of innominate artery is uncommon and has been reported only in 132 cases. In the literature there has been a solitary case report of a stroke resulting from an innominate artery injury. We present a case of traumatic injury of the innominate artery resulting in an ischemic stroke.Case presentation: A 20-year-old gentleman ejected from a two wheeler and run over by a truck presented to us with multiple bleeding facial wounds and severe crush injury of his upper torso. Bedside chest X-ray revealed a widened mediastinum and multiple rib fractures with pneumothoraces bilaterally which were drained with intercostal tubes. An hour into his stay in the ED he developed left hemiparesis. CT brain showed infarcts in right temporo-parietal and occipital regions. CT angiogram of neck vessels revealed an avulsion injury at the origin of the right innominate artery with pseudoaneurysm formation.Discussion: The innominate artery is the 2nd most common site of great vessel injury after the ascending aorta. 71% die before reaching the hospital. Patients who present to the ED are often stable with associated major injuries including rib fractures, pneumothorax and closed head injuries. The diagnosis is aided by a thorough clinical examination or a chest X-ray revealing a widened mediastinum as seen in our patient.Lessons learnt: Severe upper torso injuries involving the clavicle and upper ribs with pulse deficits or unexplained neurology should always raise a strong suspicion of major vascular injuries warranting further evaluation.