Superficial Stab Wound to Zone I of the Neck Resulting in Thyrocervical Trunk Pseudoaneurysm Presented as Recurrent Hemothorax and Successfully Managed by Coil Embolization

Abstract

Objective:Rare disease Background:Thyrocervical trunk pseudoaneurysms are rare complications that have been documented after internal jugular or subclavian venous cannulation. Even less common, these pseudoaneurysms can arise after blunt or penetrating trauma. Clinical hallmarks include an expanding supraclavicular mass with local compressive symptoms such as paresthesias, arterial steal syndrome, and Horner's syndrome. Patients may be asymptomatic, however, or present with overlying ecchymosis or the presence of a new bruit or thrill. With the risk of rupture, thyrocervical trunk pseudoaneurysm is associated with significant morbidity and mortality. Case Report:We report the case of a 27-year-old man who presented after sustaining a self-inflicted stab wound to zone I of his neck. Initial examination revealed only a superficial small laceration, but a chest x-ray revealed a pneumothorax, and tube thoracostomy returned 300 mL of bloody output. After resolution of the hemothorax and removal of the thoracostomy tube, the patient reaccumulated blood, requiring a repeat tube thoracostomy. Angiography at that time revealed a pseudoaneurysm of the thyrocervical trunk, and coil embolization was performed to obliterate the pseudoaneurysm. Conclusions:Thyrocervical trunk pseudoaneurysms can be asymptomatic, often have a delayed presentation, and can be life-threatening due to the risk of rupture and subsequent hemodynamic decline or airway compromise. While these pseudoaneurysms are well-known complications of deep penetrating injuries, they can also present following superficial penetrating injury to zone I of the neck. Selective angiography is the imaging modality of choice. Open surgical repair was traditionally the criterion standard for treatment; however, endovascular approaches are minimally invasive, feasible, and safer alternatives with reduced complications and are becoming more common.

A hybrid endovascular and open approach to rare thyrocervical trunk and subclavian pseudoaneurysms complicated by embolic brachial artery occlusion

“… 1 , 6 Thyrocervical trunk aneurysms are even less common, typically resulting from iatrogenic central venous cannulations. 3 , 7 This patient's serving injury likely avulsed the subclavian artery, resulting in a pseudoaneurysm, and continued use of the arm likely compressed the artery, leading to thrombosis and embolization to the distal brachial artery. Similar injuries have been reported in baseball pitchers and elite overhead throwing athletes.…”

“…Subclavian and thyrocervical trunk pseudoaneurysms are rare, typically resulting from trauma, and have a high risk of thrombosis, distal embolization, and mortality, if ruptured. 1 , 2 , 3 , 4 , 5 We present a case of concurrent subclavian artery branch and thyrocervical trunk pseudoaneurysms complicated by brachial artery thrombosis. These pseudoaneurysms were treated via a two-stage, hybrid endovascular and open approach with microvascular plug (MVP) embolization of the thyrocervical trunk pseudoaneurysm, covered stenting of the subclavian artery, and brachial thrombectomy with patch angioplasty.…”

An unusual case of a penetrating neck injury (PNI) illustrating the use of a “no zone” approach for the management of this injury and a review of the literature

“…A laceration of the thyrocervical trunk is unusual due to relative protection by its position deep in the root of the neck in surgical Zone 1, where it lies posterolateral to the internal jugular vein. There have been reports of a pseudoaneurysm of the thyrocervical trunk associated with penetrating injury to the root of the neck in Zone 1 [ 2 ]. This injury was also unusual in that the entry site of the metallic foreign body crossed from a Zone 2 entry point to the Zone 1 injury site.…”

Age-Specific Differences in Laryngotracheal Trauma Characteristics: A Retrospective Study of Clinical Profiles, Outcomes, and Mortality Risk

“…Managing laryngotracheal trauma involves securing the airway, controlling hemorrhage, and repairing damaged structures. In severe cases, immediate recognition and intervention are essential, with general guidelines advocating emergency tracheostomy or cricothyroidotomy to establish airway security and allow for operative exploration [ 11 , 12 ]. Conservative approaches may be selected based on the severity and location of the injury.…”