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A 4cm diameter tree branch penetrates through the left upper arm / pectoral region and passes through the left axilla where it has split at its mid section around the axillary neurovascular bundle before continuing through the sub scapular region before almost exiting the back of the body. The axillary artery is kinked by the wood but remains patent without obvious injury. The left axillary vein is focally compressed by the wood and probably completely obstructed. Near complete left lower lobe collapse is evident. No bony injury.