Abstract
Giriş: Spontan subklavyen arter yaralanmaları nadir rastlanır.
Hapşırma sonrası spontan subklavyen arter transeksiyonunu
gelişen bir olguyu sunmayı amaçladık.
Olgu Sunumu: 18 yaşında erkek hasta acil servise hapşırma sonrası
sağ omuz ağrısı şikayeti ile başvurdu. Hastanın vital bulguları ve
fizik muayenesi normaldi. Akciğer grafisinde mediasten genişliği
7 cm idi. Hasta taburcu edildi. Hasta taburculuğundan beş
saat sonra acil servise nefes darlığı ve göğüs ağrısı şikayeti ile
başvurdu. Hipotansif ve taşikardik olan hastanın sağ brakial ve
radial nabızlar palpe edilemedi. Masif hemotoraks tespit edildi.
Tüp torakostomi yapıldı, hemodimisinin hızla bozulması üzerine
acil torakotomi yapılan hastada kanama kontrolü esnasında
kardiyak arrest gelişti. Postmortem yapılan eksplorasyonda sağ
subklavyen arterin arcus aorta birleşme noktasından sirküler
olarak tam kat yırtılmaya bağlı olarak tamamen ayrıldığı (komplet
transeksiyon) görüldü.
Sonuç: Hapşırma, spontan arter diseksiyonunu tetikleyen minör
travmalar arasında yer almaktadır. 6 cm ve üzerindeki mediasten
genişliği üç kat artmış mortalite ile ilişkili bulunmuştur. Acil
servise özellikle ani hareket sonrası başlayan göğüs, sırt, omuz
ve kol ağrısı gibi yakınmalarla başvuran ve akciğer grafisinde ≥6
cm mediastinal genişlik tespit edilen hastalarda ileri görüntüleme
yapılmasının bu olgudaki gibi nadir ancak mortalitesi yüksek
hastalıkların tanınmasında faydalı olabileceğini düşünmekteyiz.
References
- Nzewi O, Slight RD, Zamvar V. Management of Blunt Thoracic Aortic In- jury. Eur J Vasc Endovasc Surg 2006; 31: 18-27. [CrossRef]
- Leonardou P, Pappas P. Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases. Ulus Travma Acil Cerrahi Derg 2012; 18: 527-30. [CrossRef]
- Assenza M, Centonze L, Valesini L, Campana G, Corona M, Modini C. Traumatic subclavian arterial rupture: a case report and review of litera- ture. World J Emerg Surg 2012 Jun 18; 7: 18. [CrossRef]
- Fabian TC, Richardson JD, Croce MA, Smith JS Jr, Rodman G Jr, Kear- ney PA et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma 1997; 42: 374-80. [CrossRef]
- Caso V, Paciaroni M, Bogousslavsky J. Environmental factors and cervical artery dissection. Front Neurol Neurosci 2005; 20: 44-53. [CrossRef]
- Umlas J. Spontaneous rupture of the subclavian artery in the Ehlers- Danlos syndrome. Hum Pathol 1972; 3: 121-6. [CrossRef]
- Verbert A, Verbist J, Peeters P, Deferm H, Haenen L. Spontaneous rupture of an aneurysm of the right subclavian artery as a first presentation of Ehlers Danlos syndrome in a 15-year old boy. Acta Chir Belg 2013; 113: 367-72.
- Slisatkorn W, Subtaweesin T, Laksanabunsong P, Warnnissorn M. Spon- taneous rupture of the left subclavian artery in neurofibromatosis. Asi- an Cardiovasc Thorac Ann 2003; 11: 266-8. [CrossRef]
- Lai V, Tsang WK, Chan WC, Yeung TW. Diagnostic accuracy of mediasti- nal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dis- section. Emerg Radiol 2012; 19: 309-15. [CrossRef]
- Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003; 108: II312-7.[CrossRef]
Abstract
Introduction: Spontaneous subclavian artery injuries are extremely rare vascular emergencies. We aimed to present a case with subclavian artery transection after sneezing. Case Report: An 18-year-old male presented to the emergency department with the complaint of right shoulder pain after sneezing. His vital signs and physical examination were all normal. On the chest radiography, the mediastinal width was 7 cm. He was discharged. He presented to the emergency department after 5 hours from discharge with complaints of chest pain and dyspnea. He was hypotensive and tachycardic. Brachial and radial pulses were not palpable. A massive hemothorax was detected. Tube thoracostomy was performed, and his hemodynamic parameters deteriorated rapidly. Urgent thoracotomy was performed, and cardiac arrest occurred during the hemorrhage control. In the postmortem exploration, a complete subclavian artery transection was confirmed at the outlet of the arcus aorta.Conclusion: Sneezing is a minor trauma that precipitates spontaneous artery dissection. It was known that a mediastinal width of over 6 cm is associated with increased mortality. An advanced radiological assessment will be useful for patients who present to the emergency department with complaints of chest, back, shoulder, or arm pain after a sudden movement and have a mediastinal width of over 6 cm
References
- Nzewi O, Slight RD, Zamvar V. Management of Blunt Thoracic Aortic In- jury. Eur J Vasc Endovasc Surg 2006; 31: 18-27. [CrossRef]
- Leonardou P, Pappas P. Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases. Ulus Travma Acil Cerrahi Derg 2012; 18: 527-30. [CrossRef]
- Assenza M, Centonze L, Valesini L, Campana G, Corona M, Modini C. Traumatic subclavian arterial rupture: a case report and review of litera- ture. World J Emerg Surg 2012 Jun 18; 7: 18. [CrossRef]
- Fabian TC, Richardson JD, Croce MA, Smith JS Jr, Rodman G Jr, Kear- ney PA et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma 1997; 42: 374-80. [CrossRef]
- Caso V, Paciaroni M, Bogousslavsky J. Environmental factors and cervical artery dissection. Front Neurol Neurosci 2005; 20: 44-53. [CrossRef]
- Umlas J. Spontaneous rupture of the subclavian artery in the Ehlers- Danlos syndrome. Hum Pathol 1972; 3: 121-6. [CrossRef]
- Verbert A, Verbist J, Peeters P, Deferm H, Haenen L. Spontaneous rupture of an aneurysm of the right subclavian artery as a first presentation of Ehlers Danlos syndrome in a 15-year old boy. Acta Chir Belg 2013; 113: 367-72.
- Slisatkorn W, Subtaweesin T, Laksanabunsong P, Warnnissorn M. Spon- taneous rupture of the left subclavian artery in neurofibromatosis. Asi- an Cardiovasc Thorac Ann 2003; 11: 266-8. [CrossRef]
- Lai V, Tsang WK, Chan WC, Yeung TW. Diagnostic accuracy of mediasti- nal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dis- section. Emerg Radiol 2012; 19: 309-15. [CrossRef]
- Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003; 108: II312-7.[CrossRef]
Details
| Other ID | JA65PK82YE |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | April 1, 2015 |
| Submission Date | April 1, 2015 |
| Published in Issue | Year 2015 Volume: 6 Issue: 2 |