Fatal delayed rupture of the subclavian artery in a patient with first‐rib fracture caused by blunt trauma

Abstract

Key Clinical MessageThis case highlights the probable association of significantly displaced posterior first‐rib fracture and jagged edges of the fracture line following blunt chest trauma with delayed ipsilateral subclavian artery rupture. Early angiography and first‐rib repair should promptly be considered under such circumstances.

Delayed subclavian artery rupture secondary to a traumatic first rib fracture

“…Although subclavian artery injury secondary to first rib fracture is well recognised, delayed rupture of the subclavian artery is extremely rare and has only been reported once before by Yonezawa et al [4]. In similar circumstances to the case presented here, the patient suddenly deteriorated 35 h after initial presentation and although angiography was used to identify the source of bleeding and resuscitative and emergency thoracotomy performed, unfortunately the patient did not survive.…”

Tension hemothorax due to iatrogenic subclavian artery perforation: Hybrid management of a very rare complication

“…Tension hemothorax is a well-known complication of trauma and thoracic aortic aneurysm rupture [[1], [2], [3], [4]], while central venous line placement usually causes massive hemothorax [5]. In this case the complication of central venous catheter placement caused a subclavian artery laceration and a pleural lesion that led to a far rarer complication such as tension hemothorax, which is the cause of a hypovolemic and obstructive shock at the same time.…”

“…Tension hemothorax is a rare event, due to different causes: trauma with fracture of the first rib [1,2], ruptured thoracic aorta aneurysms [3,4], or as a complication of central venous line placement due to inadvertent artery puncture or cannulation [5]. Tension hemothorax leads to both hypovolemic and obstructive shock and request emergency management.…”

Atraumatic bleeding of the subclavian artery 20 years after surgical treatment of pneumothorax

“…Bleeding of the subclavian artery is a fatal condition. Many reports of subclavian artery injury describe a direct association with first rib fractures [1] [2] [3], and some describe complication with von Recklinghausen disease [4]. Bleeding may be controlled by either open repair (median sternotomy, lateral thoracotomy) or endovascular repair.…”