Rupture of subclavian artery pseudoaneurysm

Case contributed by Dr Mohamed Saber

Presentation

Long-stay polytraumatic patient with right upper neck swelling.

Patient Data

Age: 25 years
Gender: Male

Right cervicothoracic large vascular lesion seen smoothly indenting the right lung apex and closely related to the vascular structures, it measures 4x4.5x6 cm. The lesion is almost completely enhanced in the late arterial phase with direct communication with the proximal right subclavian artery, the connection measures 5mm diameter and 10mm length. This picture is consistent with a right subclavian artery pseudoaneurysm.

Tracheostomy and nasogastric tubes are noted.

The pseudoaneurysm was treated by a stent placement with stable condition. A few weeks later, the patient presented with shock and cardiac arrest.

Large right pleural collection of complex density with basal hyperdensity creating fluid-fluid level consistent with hemorrhagic collection (hemothorax) with underlying near-total right lower lung lobe collapse. A stent is also noted.

Pleural drain confirms massive hemothorax.

Case Discussion

Here is a fatal consequence of a right subclavian artery pseudoaneurysm. In spite of the management with a stent, the lesion was spontaneously ruptured into the pleural cavity creating massive hemothorax. Unfortunately, the patient was passed away a few hours after the bleeding with failed resuscitation.

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