Presentation
Chronic renal disease, with a history of a failed attempt to place a left hemodialysis catheter and left upper limb edema.
Patient Data
The venous Doppler of the left upper limb is normal, with no evidence of thrombosis.
However, at the level of the first portion of the left subclavian artery, there is echogenic material surrounding a lumen that exhibits uptake in color Doppler mode, displaying a 'ying-yang' appearance. Evaluation in power Doppler mode reveals a pulsatile spectral wave with arterial characteristics. These findings are suggestive of a pseudoaneurysm in one of the branches of the subclavian artery.
The angiotomography identifies sacculation of the left thyrocervical trunk associated with pooling of contrast medium at this same site, findings that confirm the suspicion of pseudoaneurysm of the thyrocervical trunk. The sacculation of the left thyrocervical trunk is surrounded by hyperdense material, which causes a mass effect and compresses the left subclavian vein at the level of its confluence with the jugular vein.
Case Discussion
Pseudoaneurysms of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries.
Most of these are caused by iatrogenic needle puncture of the thyrocervical trunk at the time of attempted internal jugular vein catheterization.
The typical clinical symptom of pseudoaneurysms is a pulsatile mass with bruit at the injured site.
Pseudoaneurysm usually requires intervention because of the risk of complications, including pain, a mass effect involving adjacent structures, and rupture.
Co-authors: López Arriaza Carlos, MD, Radiology, 3rd year resident. Velásquez de León Cristian Eduardo, MD, Radiology, 2nd year resident.
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