Thoracic Outlet Syndrome Caused by a Pseudoaneurysm After Pseudarthrosis of the Clavicle

Abstract

Clavicle fractures are common, with the majority treated conservatively. If treated conservatively, pseudarthrosis of the clavicle is reported in up to 3% of the cases. In rare cases, pseudarthrosis of the clavicle may cause pseudoaneurysm formation, resulting in compression of the brachial plexus and the adjoining vessels, which may produce neurological symptoms and circulatory disorders. Here, we describe two cases of the late onset of pseudoaneurysm formation after pseudarthrosis of the clavicle. Both cases were remarkable because they showed clinical symptoms of TOS. Therefore, surgical treatment was performed and included claviculectomy, resection of the pseudoaneurysm and interposition grafting with an artificial prosthesis. One year after the operation, both patients showed excellent upper extremity function without any deficit of vascular, sensorial or motorial function. Patient's history and radiological findings are the keys to diagnosis. Without treatment, the prognosis is poor with spontaneous development of bleeding or gangrene. Therefore, surgical treatment has to be performed, especially when neurological symptoms occur.

Endovascular Management of Suprascapular Artery Pseudoaneurysm

“…Fractures to the clavicle are common in blunt-force trauma, representing approximately 2% to 5% of all fractures and 44% of those in the shoulder girdle. Reports of delayed neurovascular complications associated with clavicular fractures are described in the literature, including formation of pseudoaneurysms, which can go unrecognized for years (2,4,5). This appeared to be the case for our patient.…”

“…Pseudoaneurysms have various etiologies, most commonly trauma or iatrogenic injury after endovascular procedures. Other causes include tumor invasion, infection, inflammatory disorders including vasculitis, and penetrating atherosclerotic ulcers (2,4).…”

Congenital, Acquired, and Trauma-Related Risk Factors for Thoracic Outlet Syndrome—Review of the Literature

“…Bilateral incidence was in the range of 10% and usually cooccurred with other bony aberrations, such as the cervical rib [37]. The TOS caused by this pathogenesis is very rare, but there are some cases described in the literature [38][39][40][41][42][43].…”