Compressão da artéria subclávia por pseudoartrose de clavícula: apresentação na quinta década de vida

Abstract

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.Keywords: subclavian artery; thoracic outlet syndrome; critical ischemia. ResumoA compressão da artéria subclávia no desfiladeiro torácico é um fenômeno amplamente conhecido. Anormalidades ósseas, como a pseudoartrose da clavícula, podem raramente causar compressão arterial a esse nível. A pseudoartrose pode desenvolver-se em decorrência de um trauma, que é a forma mais comum, ou ser congênita. Os autores descrevem o caso de uma paciente de 44 anos com quadro de isquemia crítica de membro superior direito. Apresentava história de fratura não tratada de clavícula direita aos 9 meses de idade que evoluiu com pseudoartrose e compressão extrínseca com oclusão da artéria subclávia. O segmento da clavicula acometido pela pseudoartrose foi ressecado e realizada uma tromboembolectomia tardia das artérias subclávia, braquial e distais, com boa evolução.Palavras-chave: artéria subclávia; síndrome do desfiladeiro torácico; isquemia crítica.

Clavicular non-union as an undiagnosed cause of progressive limb-threatening upper extremity ischemia

“…Interestingly, there was a 50-year interval between clavicular fracture and the occurrence of limb threatening ischemia. Similarly, in recent single case reports limb ischemia developed 43 and 30 years after fracture of the clavicle [2,3]. That long interval may have contributed…”

“…History of the fracture of the clavicle, even if remote, should draw attention to the possible arterial compression syndrome. The arterial compression by the pseudoarthrosis of the clavicle is a rare but already described cause [2,3]. Interestingly, there was a 50-year interval between clavicular fracture and the occurrence of limb threatening ischemia.…”

Current Concepts in the Management of Neurogenic Thoracic Outlet Syndrome: A Review

“…16 Mid-shaft clavicular fracture malunion may also cause compression of the thoracic outlet, resulting in nTOS. [17][18][19][20] Additional causes of TOS include malignancies, such as Pancoast tumors (superior sulcus or apical lung tumors), which can invade and compress the brachial plexus. 21…”