Delayed presentation of a pseudoaneurysm of the subclavian and axillary artery – the importance of vigilance

Sandiford, Nemandra A; Tsitskaris, Kostantinos; Erritty, Matthew

doi:10.1258/jrsm.2009.090454

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…The overall incidence of proximal humerus fractures is approximately 73/100,000, with 75% of these occurring in the elderly and a further subset, 5%, displaying vascular complications [7]. However, management of such fractures is not well studied and there are few reports in the literature of vascular injury in children with proximal humerus fractures [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Other findings include periclavicular hematomas, neurovascular deficits, and pain or contusions around the shoulder joint [12]. Physical exam has been found to be highly predictive of vascular injury, although the presentation can be delayed, as described by Sandiford et al with symptoms occurring up to forty-eight hours later [7]. As there is significant morbidity associated with delays in diagnosis and treatment of such injuries, it is essential to carefully evaluate patients at risk for vascular injury [7,9].…”

Section: Discussionmentioning

confidence: 99%

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Severe Infraclavicular Displacement of a Proximal Humerus Fracture with Concomitant Olecranon Fracture in a Pediatric Patient

Shieh

McMichael

Knudsen-Robbins

et al. 2022

Case Reports in Orthopedics

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Proximal humerus fractures with severe medial displacement of the humeral head are rare in adults and especially so in children. Concomitant vascular/neurovascular injury is even more uncommon but must be considered as the associated complications can carry significant morbidity. We present a case of a 12-year-old transported to the ED after a mountain bike accident in which she lost control and hit a cement wall, injuring her left upper extremity (LUE). Despite a normal vascular/sensory exam, imaging demonstrated a left comminuted proximal humerus fracture with the humerus displaced medially into the thoracic inlet as well as concern for left subclavian vessel injury. Given the possibility of vascular injury and the severe humeral head displacement, she was taken to surgery with orthopedic and vascular surgical teams. Although surgical exploration did not reveal vascular injury, this case underlines the importance of maintaining a high index of suspicion for neurovascular injury with such fractures as prompt intervention may reduce the likelihood of complications. This case also underscores the need for further research into the management of pediatric proximal humerus fractures in early adolescence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe Infraclavicular Displacement of a Proximal Humerus Fracture with Concomitant Olecranon Fracture in a Pediatric Patient

Shieh

McMichael

Knudsen-Robbins

et al. 2022

Case Reports in Orthopedics

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“…Pseudoaneurysms of the axillary artery are a rare complication after blunt trauma in the axillary region [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. In the case of blunt trauma, a shoulder joint-related bone injury may occur, and most often an anterior dislocation [ 3 , 4 , 5 , 8 ]; axillary artery damage has been reported with a prevalence of about 0.3% [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Injury to the shoulder region is the most common complication of a dislocated shoulder joint, humeral fractures, plexus brachialis injuries, and also vascular injury [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Pseudoaneurysms represent an encapsulated hematoma in communication with the lumen of a ruptured vessel [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Traumatic pseudoaneurysm of the axillary artery is a rare sequela of injury to the shoulder region [ 1 , 3 , 5 , 9 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Neglected Rupture of Right Axillary Artery Pseudoaneurysm Mimicking a Soft Tissue Tumor

et al. 2020

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Traumatic lesions of the axillary artery itself are limited to 2.9–9% of major arterial injuries. Pseudoaneurysms represent a pulsating encapsulated hematoma in communication with the lumen of a ruptured vessel. Traumatic pseudoaneurysm of the axillary artery is a rare sequela of injury to the shoulder region. We describe a case of posttraumatic pseudoaneurysm involving the axillary artery, which was initially misdiagnosed as an aggressive soft tissue tumor. The man presented 10 years after an injury from a fall from a tree with a slowly growing mass in the right upper limb region and reduced range of movement. This is a neglected case with a history of traditional massage. The patient presented a pathologic fracture of the right proximal humerus and dislocation of the glenohumeral joint. At the beginning, it was suggested to be a primary soft tissue tumor, but after several examinations, including comparable X-ray, ultrasound, and histopathology, the results did not support a soft tissue tumor. Magnetic resonance imaging and computed tomography angiography (CTA) finally confirmed the finding of a pseudoaneurysm of the right axillary artery associated with a huge hematoma with different age of the bleeding product and granulation tissue. This case demonstrates the necessity of early diagnosis of axillary artery pseudoaneurysm to prevent complications after a history of trauma. CTA is a useful modality to evaluate vascular injury and provides valuable information.

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Vasculair letsel bij een subcapitale humerusfractuur

Goei

Eland

Vries-Verbaas

et al. 2014

TIJD. TRAUMACHIRURGIE

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Delayed presentation of a pseudoaneurysm of the subclavian and axillary artery – the importance of vigilance

Cited by 6 publications

References 11 publications

Severe Infraclavicular Displacement of a Proximal Humerus Fracture with Concomitant Olecranon Fracture in a Pediatric Patient

Severe Infraclavicular Displacement of a Proximal Humerus Fracture with Concomitant Olecranon Fracture in a Pediatric Patient

A Rare Case of Neglected Rupture of Right Axillary Artery Pseudoaneurysm Mimicking a Soft Tissue Tumor

Vasculair letsel bij een subcapitale humerusfractuur

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