Ruptured subclavian artery pseudoaneurysm following a shoulder massage on a background of clavicle non-union

Abstract

We present an unusual case of ruptured subclavian artery pseudoaneurysm following hydrotherapy and shoulder massage session on a background of clavicle non-union.Following a clavicle fracture 16 years ago, which was managed conservatively, a woman in her 30s presents over a decade later with a ruptured subclavian artery pseudoaneurysm.The original midshaft clavicle fracture was sustained 16 years ago. Conservative management was agreed, and she was discharged. Six years ago, she developed a small subclavian artery pseudoaneurysm which was kept under surveillance for 12 months with no active intervention required.Over the following years, she continued to have intermittent shoulder girdle discomfort and neuropathic symptoms. On this presentation, after a sports massage, she presented with rapid-onset supraclavicular and axillary swelling. This was diagnosed as a ruptured subclavian artery pseudoaneurysm and was treated with emergency radiological-guided stenting and subsequent internal fixation of the clavicle non-union.The patient then attended regular orthopaedic and vascular follow-up to ensure her clavicle fracture unites and the graft remains patent.We discuss the case presentation and management of this unusual injury.

Rupture of subclavian artery pseudoaneurysm after clavicle nonunion surgery in adolescents: a case report

“…The initial part of the abnormal subclavian artery was injured during brachial plexus block anesthesia and operation, resulting in the formation and rupture of subclavian artery pseudoaneurysm. Recently, Lawson et al reported a case of chronic subclavian artery pseudoaneurysm due to clavicle nonunion[11]. The patient's pseudoaneurysm ruptured after massage, emergency vascular stent implantation under radiography, and secondary internal xation of clavicular nonunion.…”