Brachiocephalic trunk pseudoaneurysm

Case contributed by Dr James Harvey

Presentation

Motorbike accident. Pain in the left shoulder and chest. Haemodynamically stable.

Patient Data

Age: 20 years
Gender: Male

Chest x-ray

x_ray

Supine projection.

  • There is widening of the superior mediastinum and loss of the normally sharp outline of the aortic arch.
  • Fracture of the medial left clavicle.
  • No pneumothorax.

CT chest

ct
  • A 2 mm outpouching is seen within the proximal brachiocephalic artery likely representing a small traumatic pseudoaneurysm.
  • High-attenuation fat-stranding within the superior mediastinum in keeping with hemorrhage
  • No thrombus/dissection involving the aorta
  • Comminuted fracture of the proximal left clavicular epiphysis. ┬áMinimally displaced fractures of the anterior aspects of the left second and third ribs.
  • Moderate sized right hemothorax.

Key images

Annotated image

Focused images of the small outpouching.

The patient was admitted under cardiothoracic surgery. He was discharged following 48 hours of observation.
A follow-up CT was planned for 3 months.

Case Discussion

Mediastinal hematoma may be seen in blunt trauma, such as deceleration injuries. A widened mediastinum on CXR should raise concern for a vascular injury, particularly a traumatic aortic injury. Other causes include small vessel injury, fractures of the sternum and vertebral column.
Mediastinal hematoma may potentially lead to extrapericardial cardiac tamponade.

Pseudoaneurym of the brachiocephalic trunk is a rare finding. In this case, the small pseudoaneurysm was managed conservatively.

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