Penetrating neck trauma

Case contributed by Zach Drew


Dirt bike accident, impaled by tree branch.

Patient Data

Age: 40 years
Gender: Male

Large penetrating wooden foreign body extending from the right anterolateral aspect of the neck, traversing inferomedially posterior to the right sternocleidomastoid, entering the thoracic inlet with tip of the foreign body in the superior mediastinum. The tip of the foreign body lies close to the aortic arch and abuts the origin of the left subclavian artery and displaces the proximal left common carotid which winds around the foreign object. Incidental aberrant origin of the right subclavian artery from the aortic arch. The right internal jugular vein is displaced medially and compressed, and not visualized distally. 

No active arterial extravasation or traumatic pseudoaneurysm. 

Diffuse subcutaneous emphysema and pneumomediastinum. Large left pneumothorax. 

Case Discussion

The foreign body was removed surgically, with traumatic thrombosis of the distal right IJV. All other major neck and mediastinal vessels were intact. 

The case is notable for proximity of the penetrating foreign body to major vessels including the aortic arch and carotid arteries - without significant injury. 

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