Thyrocervical Trunk Pseudoaneurysm

Abstract

Thyrocervical trunk aneurysms are very rare. Only a few cases have been reported in the literature. We present an interesting case of an eight-year-old boy who came to us with a right side neck pulsating mass which was painless. He had no history of direct trauma or catheterization, and no history of upper limb embolization or associated disease, i.e., vasculitis. There were no signs of brachial plexus compression. Case ReportAn eight-year-old boy was referred from another hospital with a two-month history of a mass in the right supraclavicular area which was gradually increasing in size (Figure 1). There was no history of trauma or catheterization, or family history of aneurysms or vasculitis diseases. He had had a CT scan in the local hospital and was diagnosed as a case of right subclavian artery aneurysm and referred for further management.Neck examination showed a right supraclavicular mass around 4 x 5 cm which was pulsating, firm, mobile and non-tender. There was no bruit and transillumination test was negative. Right upper limb pulses and neurological examination were normal. The rest of the vascular and physical examinations were normal. Ultrasound of the neck showed a mass measuring 5 x 3 x 3 cm. CT scan without contrast showed an aneurysm-like mass in the right supraclavicular area filled in by a large thrombus. The CT scan with contrast showed the mass again with evidence of enhancement (Figure 2). Doppler ultrasound showed a flow within the mass of undetermined origin. The patient had an aortic arch angiogram which showed no evidence of aneurysm in the right subclavian artery (Figure 3). The venogram was normal. A selective angiogram was repeated, and this showed that the aneurysm was supplied by a small branch of the thyrocervical trunk of the right side (Figure 4). This was selectively catheterized and embolized with coil. Almost complete obliteration of the flow was noted. A decision was then made to go for surgery through a right transverse incision, using the supraclavicular approach. A large aneurysm with a major feeder coming out of the thyrocervical trunk was double ligated and the whole aneurysm was excised. The patient did well and was discharged in good condition. Histopathology results revealed a pseudoaneurysm with an organized thrombus, without any evidence of inflammatory process or other pathological lesion. DiscussionAneurysms of the thyrocervical trunk are rare. There are only three reported cases in the English literature. One case presented with features of C8/TI root compression.1 Another case of aneurysm was reported with features of vocal cord paresis. A case of pseudoaneurysm of the thyrocervical trunk as a complication of failed internal jugular venous catheterization 2 has also been reported. The presentation in our patient was totally different from the previous reported cases. He presented with a painless mass which was gradually increasing in size. The most common cause of these aneurysms in young patients is a direct trauma or internal jugular venous catheterization. Ot...

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

“…There have also been spontaneous thyrocervical pseudoaneurysms reported in the literature. For example, an 8-year-old boy presented with a painless expanding pulsatile supraclavicular mass in the absence of any bodily trauma [3]. In another case, a 60-year-old woman presented with altered mental status, unsteady gait, speech difficulty, Horner's syndrome, and a 2-cm neck mass.…”

“…Blind approaches, multiple cannulation attempts, and inadvertent arterial puncture increase the likelihood of pseudoaneurysm formation [1,2]. Additional etiologies include trauma, infection, and fibromuscular hyperplasia [3]. These vascular anomalies typically present as a painless, pulsatile, supraclavicular mass but can also present as massive hemothorax, recurrent hemothorax, or hemoptysis [4][5][6].…”