Internal Jugular Aneurysm, Lymphocele and Axillary Arteriovenous Fistula Following a Bullet Wound

Abstract

THE UNPREDICTABLE behavior of a missile coursing through human tissues has long been a matter of record. ',4 5' 7' 9 The following report is an instance of multiple blood and lymph vessel injury by a bullet. It is of added interest in that the clinical data suggest an unusual physiologic sequel to the particular anatomic pattern found in this patient.Case Report H. P., a 48-year-old machinist (U 58-2455), was admitted to Beekman Downtown Hospital on June 19, 1958 with a complaint of enlarging, pulsating tumor in his neck. Thirteen years before he had suffered a bullet wound just above the right clavicle. This healed rather promptly. Two years after this injury he first noticed a rounded swelling at the base of the right neck. Since that time, during the 10 years preceding admission, a progressive enlargement of the mass above the right clavicle took place. During the year before admission the patient first noted progressive swelling of the entire right upper extremity. This was associated with a dull persistent pain in the right arm usually brought on by work or exercise and disappearing with recovery from fatigue. Despite this symptom he continued his usual work and other activities. There never was any complaint of dyspnea, orthopnea, tachyeardia, palpitation, cough, hemoptysis or vertigo. The patient was certain that he had never had headache or visual disturbance.Physical examination revealed a robust, white, middle-aged man whose right upper extremity was obviously enlarged. His On the basis of the history, physical and laboratory findings, a diagnosis of right subclavian arteriovenous fistula was made. Operation

Traumatic Arteriovenous Fistula of the Right Common Carotid Artery and Internal Jugular Vein Successfully Treated By Vascular Reconstruction Under Hypothermia

“…The diagnosis of this lesion can be made readily by the past history, pulsating tumor and continuous bruit. However, Blum et al 8 reported a 48-year-old man with enlarging pulsating tumor in the right neck just above the clavicle. Thirteen years previously, the patient sustained injury in this region.…”